AccountId: 011433970860
ContactId: ebeec5e0-0188-441d-8db3-dd811debcfbf
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 231380 ms
Total Talk Time (AGENT): 120841 ms
Total Talk Time (CUSTOMER): 71096 ms
Interruptions: 1
Overall Sentiment: AGENT=1.2, CUSTOMER=1.3
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/05/29/ebeec5e0-0188-441d-8db3-dd811debcfbf_20250529T18:41_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] Hello, my name is [PII]. I'm calling from, um, Doctor [PII]'s office. I wanted to inquire the patient's benefits, um, to see what the second, what this gap insurance covers.
[AGENT][NEUTRAL] OK, and you said your name is [PII], is that correct?
[CUSTOMER][NEUTRAL] Yes.
[AGENT][NEUTRAL] OK, and you're needing to get benefits. Do you also need eligibility, [PII]?
[CUSTOMER][NEUTRAL] Um, sure, yes.
[AGENT][POSITIVE] Yes, I can help you with both and what is your callback number?
[CUSTOMER][NEUTRAL] Yes, [PII].
[AGENT][NEUTRAL] Thank you. And the member's policy number, please?
[CUSTOMER][NEUTRAL] Yes, 0 I'm sorry, 02513186 M as in Mary, L as in Larry 8.
[AGENT][POSITIVE] OK, thank you one moment.
[CUSTOMER][NEUTRAL] And
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Bye
[AGENT][NEUTRAL] And [PII], 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] Yeah
[CUSTOMER][NEUTRAL] Yes, [PII].
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][POSITIVE] I'm so sorry?
[AGENT][NEUTRAL] And her date of birth?
[CUSTOMER][NEUTRAL] I guess I just
[CUSTOMER][NEUTRAL] Yes, it is [PII].
[AGENT][NEUTRAL] OK, thank you. So I do show that she is a subscriber on the supplemental policy and it is active with an effective date of [PII].
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] And what type of benefit information do you need for her inpatient, outpatient or office?
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] It will be outpatient. I wanted to know if they covered like her co-pays for outpatient surgeries.
[AGENT][NEUTRAL] OK, so her outpatient benefit maximum per calendar day for covered outpatient services is $3000 with no outpatient deductible per covered person per calendar day.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] OK, perfect. So for instance, if a patient has a copay of 3000 technically the secondary will cover that?
[AGENT][NEUTRAL] Again, I can't guarantee payment. I can only verify what the benefits are, but she does have an outpatient benefit maximum of $3000 per calendar day for covered outpatient services.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][POSITIVE] OK, perfect.
[AGENT][NEUTRAL] Now, because this is a supplemental policy, [PII], when the claim is submitted to us for review, we will have to also have a copy of her primary insurance company's explanation of benefits.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] And then once we have processed the claim here at APL, we do have a portal in which you all should be able to check your claim status with us and the website for the portal is located at [PII].
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][POSITIVE] OK perfect.
[AGENT][NEUTRAL] OK. Well, is there anything else that I can help you with?
[CUSTOMER][POSITIVE] Alright, perfect.
[CUSTOMER][NEUTRAL] No, that's all. Do you have like a reference number I can go by?
[AGENT][NEUTRAL] Sure, you would use my name that I gave you along with today's date.
[CUSTOMER][POSITIVE] OK, I'm just so sorry, can you provide me your name?
[AGENT][NEUTRAL] [PII], and I spell it [PII]
[CUSTOMER][POSITIVE] Perfect. And today's date. Thank you so much. I really appreciate it, [PII].
[AGENT][POSITIVE] Yes, ma'am. OK, well, you're very welcome, [PII], and thank you again for calling APL. I hope you have a nice afternoon.
[CUSTOMER][NEUTRAL] You too bye bye.
[AGENT][POSITIVE] Thank you. Bye-bye.