AccountId: 011433970860
ContactId: e6069c02-b25b-47b2-87ab-a94b790d1bea
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 215520 ms
Total Talk Time (AGENT): 135451 ms
Total Talk Time (CUSTOMER): 44955 ms
Interruptions: 0
Overall Sentiment: AGENT=1.7, CUSTOMER=1.1
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/01/02/e6069c02-b25b-47b2-87ab-a94b790d1bea_20250102T16:19_UTC.wav
--------------------------------------------
[AGENT][POSITIVE] Good Morning. Thank you for calling APL. This is [PII]. How can I help you?
[CUSTOMER][NEUTRAL] Good morning. I'm calling on behalf of Homestead Hospital to verify member eligibility and benefits for an emergency room visit with us.
[AGENT][NEUTRAL] OK. So you're needing eligibility and benefit information for a member, you said, and this would be for an emergency room visit, is that correct?
[CUSTOMER][NEUTRAL] Yes ma'am.
[AGENT][POSITIVE] Yes, I can help you with that. And who am I speaking with, please?
[CUSTOMER][NEUTRAL] My name is [PII].
[AGENT][NEUTRAL] Thank you. And [PII], what is your callback number?
[CUSTOMER][NEUTRAL] [PII]
[AGENT][POSITIVE] Thank you and the member's policy number, please.
[CUSTOMER][NEUTRAL] 148
[CUSTOMER][NEUTRAL] 0315
[AGENT][POSITIVE] Thank you one moment.
[AGENT][NEUTRAL] And no more any information that I do provide today will be a verification of benefits and not a guarantee of payment. What is your patient's name and their date of birth?
[CUSTOMER][NEUTRAL] [PII].
[CUSTOMER][NEUTRAL] [PII].
[AGENT][POSITIVE] OK. Thank you.
[AGENT][NEUTRAL] So I do see that she is the subscriber on the supplemental policy and the supplemental policy is active with an effective date of [PII].
[AGENT][NEUTRAL] And her outpatient benefit maximum?
[AGENT][NEUTRAL] It is $500 per covered person per calendar day for covered outpatient services, and there is no emergency room deductible per covered person per occurrence.
[CUSTOMER][POSITIVE] All [PII], and we have a group number. I'm sorry.
[AGENT][NEUTRAL] And um
[AGENT][NEUTRAL] Oh, I'm sorry. No, go ahead. The group number?
[CUSTOMER][NEUTRAL] Uh, the, yeah, I have 15494, is that correct?
[AGENT][POSITIVE] Yes, sir, that is correct. Uh-huh.
[AGENT][NEUTRAL] And also, um more, if there's a way that you can make a note, when the claim is submitted to APL for review, we must also have a copy of her primary insurance company's explanation of benefits as well.
[AGENT][NEUTRAL] And then once our claim has been processed here at APL we do have a portal in which claim status can be checked and and also have access to the EOBs for APL and our website is secured.
[AGENT][NEUTRAL] [PII].
[CUSTOMER][NEUTRAL] Now this website you're saying I could check for eligibility as well?
[AGENT][NEUTRAL] No, no, sir, claim status and EOB, uh, once the claim has been reviewed and processed by APL, but the initial claim when it is submitted to us for review, you all must include a copy of her primary insurance company's explanation of benefits.
[CUSTOMER][NEUTRAL] Oh
[CUSTOMER][NEUTRAL] [PII].
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] For our review as well.
[CUSTOMER][NEUTRAL] OK, I'll notate the account that information.
[AGENT][NEUTRAL] OK. Well, is there anything else I can help you with today?
[CUSTOMER][POSITIVE] No, ma'am, that'll be all thank you very much.
[AGENT][POSITIVE] Well, you are certainly welcome and thank you again for calling APL. I hope you have a wonderful day and a happy New Year.
[CUSTOMER][POSITIVE] Thank you.
[AGENT][NEUTRAL] Mm bye-bye.
[CUSTOMER][NEUTRAL] Alright