AccountId: 011433970860
ContactId: eae2a05f-0f7f-48c7-bd2e-c092e50fd198
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 235789 ms
Total Talk Time (AGENT): 114437 ms
Total Talk Time (CUSTOMER): 60870 ms
Interruptions: 1
Overall Sentiment: AGENT=1.5, CUSTOMER=1.1
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/04/16/eae2a05f-0f7f-48c7-bd2e-c092e50fd198_20250416T18:26_UTC.wav
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[AGENT][NEUTRAL] Good afternoon. Thank you for calling APL. This is [PII]. How can I help you?
[CUSTOMER][NEUTRAL] Hi, good afternoon. This is [PII] calling with Ba this outpatient. I'm calling in reference to a mute outpatient. I'm trying to obtain uh outpatient benefit.
[AGENT][NEUTRAL] OK, [PII], do you need only benefit information or do you also need eligibility?
[CUSTOMER][NEUTRAL] Uh, also, I need eligibility as well, and to see how much is remaining on the patient's account for all patients.
[AGENT][POSITIVE] Yes, ma'am. I can help you with that. And what is a good callback number for you, please?
[CUSTOMER][NEUTRAL] Yes, [PII].
[AGENT][POSITIVE] Thank you and the member's policy number please, [PII].
[CUSTOMER][NEUTRAL] 02570532.
[AGENT][NEUTRAL] OK, thank you. One moment please.
[CUSTOMER][NEUTRAL] Yes.
[AGENT][NEUTRAL] And any information that I provide for you would be a verification of benefits and not a guarantee of payment. What is your patient's name and date of birth?
[CUSTOMER][NEUTRAL] [PII]. Date of birth [PII].
[AGENT][POSITIVE] Thank you.
[CUSTOMER][POSITIVE] You're welcome.
[AGENT][NEUTRAL] OK, so I do show that she is the subscriber on the supplemental policy, [PII], and the supplemental policy is active with an effective date of [PII].
[AGENT][NEUTRAL] And you said that you were needing her outpatient benefit maximum, is that correct?
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][POSITIVE] Yes, you got it right.
[AGENT][NEUTRAL] OK, so she has an outpatient benefit maximum of $3000 per covered persons per calendar year for covered outpatient services.
[AGENT][NEUTRAL] With no deductible.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEGATIVE] not deductible.
[AGENT][NEUTRAL] And you also wanted to know what has been used?
[CUSTOMER][NEUTRAL] Yes.
[AGENT][NEUTRAL] OK, one moment.
[AGENT][NEUTRAL] And as of now for this calendar year, she has used $60 of her benefits.
[CUSTOMER][NEUTRAL] 16
[AGENT][NEUTRAL] 6060.
[CUSTOMER][NEUTRAL] 0 60,060. OK, perfect. Thank you so much. And the last thing I may need is gonna be the initial to your last name and the reference number.
[AGENT][NEUTRAL] Uh-huh.
[AGENT][NEUTRAL] My name in today's date will be the reference number. Um, the first initial to my last name is S as in Sierra, and [PII], when the claim is submitted to APL, we will also have to have a copy of the primary insurance company's explanation of benefits as well. And then once we process the claim here, we do have a portal that you should be able to check our claim status in by going to secured.
[AGENT][NEUTRAL] [PII].
[AGENT][NEUTRAL] OK. And again, is there anything else I can help you with?
[CUSTOMER][NEUTRAL] OK, and that will be everything.
[CUSTOMER][POSITIVE] No, that will be everything for today. Thank you so much. I appreciate your help.
[AGENT][POSITIVE] OK. You're welcome, [PII]. It was my pleasure and thank you for calling APL. I hope you have a great afternoon.
[CUSTOMER][POSITIVE] Same to you. Thank you. Bye.
[AGENT][POSITIVE] Yes ma'am. Thanks. Bye bye.