AccountId: 011433970860
ContactId: e5dad520-0b27-42e8-bbb4-efacf15be8f6
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 187919 ms
Total Talk Time (AGENT): 97591 ms
Total Talk Time (CUSTOMER): 34448 ms
Interruptions: 0
Overall Sentiment: AGENT=1.6, CUSTOMER=0.6
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/02/26/e5dad520-0b27-42e8-bbb4-efacf15be8f6_20250226T17:49_UTC.wav
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[AGENT][POSITIVE] Good, good morning. Thank you for calling APL. This is [PII]. How can I help you?
[CUSTOMER][NEUTRAL] Hi [PII], I'm calling to verify member benefits for outpatient.
[AGENT][NEUTRAL] OK. Do you also need eligibility or only benefits?
[CUSTOMER][NEUTRAL] Um, I guess because the patient's active, yeah.
[AGENT][NEUTRAL] OK. So you do need eligibility and benefits?
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][POSITIVE] Yes, ma'am. I can help you with that. And who am I speaking with?
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] Thank you. And [PII], what's your callback number?
[CUSTOMER][NEUTRAL] [PII]
[AGENT][POSITIVE] Thank you and the member's policy number, please.
[CUSTOMER][NEUTRAL] 786-57, sorry, the member's telephone number?
[AGENT][NEUTRAL] No, the member's policy number so that I can look up their information.
[CUSTOMER][NEUTRAL] Oh,
[CUSTOMER][NEUTRAL] It's 02579028.
[AGENT][POSITIVE] Thank you, one moment please.
[CUSTOMER][POSITIVE] Thank you.
[AGENT][POSITIVE] You're welcome
[AGENT][NEUTRAL] OK, and just get any information that I do provide for you today would be a verification of benefits and not a guarantee of payment. What is your patient's name please and the date of birth?
[CUSTOMER][NEUTRAL] It's [PII] [PII].
[AGENT][NEUTRAL] OK, thank you. So I do say she is the subscriber on the supplemental policy and it is active with an effective date of [PII].
[AGENT][NEUTRAL] And she has an outpatient benefit max per calendar year for covered outpatient services of $6500 and there is no outpatient deductible per covered person per calendar year.
[CUSTOMER][NEUTRAL] OK, um, the remaining?
[AGENT][NEUTRAL] And this is for your this calendar year?
[CUSTOMER][NEUTRAL] Yeah.
[AGENT][NEGATIVE] OK, as of now, she has not used any of her benefits.
[CUSTOMER][NEUTRAL] Alright, thank you. Is there a reference number to the call?
[AGENT][NEUTRAL] Yes ma'am, there is, um, and [PII], when the claim is submitted to APL for review, we must also have a copy of the primary insurance company's explanation of benefits along with the claim.
[CUSTOMER][NEUTRAL] I
[AGENT][NEUTRAL] And then once we've processed our claim we do have a portal that you should be able to check claim status in for us by going to [PII].
[CUSTOMER][NEUTRAL] [PII]
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] And you would use my name that I gave you along with today's date as your call reference number.
[CUSTOMER][POSITIVE] Alright thank you have a good day bye.
[AGENT][POSITIVE] You too, thank you again for calling APL.