AccountId: 011433970860
ContactId: ee015a82-59f2-4548-b2a7-5e0670c277df
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 252500 ms
Total Talk Time (AGENT): 133980 ms
Total Talk Time (CUSTOMER): 51568 ms
Interruptions: 0
Overall Sentiment: AGENT=1.3, CUSTOMER=0.5
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/04/24/ee015a82-59f2-4548-b2a7-5e0670c277df_20250424T17:57_UTC.wav
--------------------------------------------
[AGENT][NEUTRAL] Good afternoon. Thank you for calling APL. This is [PII]. How can I help you?
[CUSTOMER][NEUTRAL] Hi, good afternoon. I'm calling to check benefits and eligibility for a patient.
[AGENT][NEUTRAL] OK, you have one patient that you're needing benefits and eligibility for, is that correct?
[CUSTOMER][NEUTRAL] Yes.
[AGENT][POSITIVE] OK, yes ma'am, I can help you with that and.
[CUSTOMER][NEUTRAL] Hello?
[AGENT][NEUTRAL] Who am I speaking with, please?
[CUSTOMER][NEUTRAL] My name is [PII].
[AGENT][POSITIVE] Yes, ma'am, I can help you.
[AGENT][NEUTRAL] And I, what is your callback number?
[CUSTOMER][NEUTRAL] I'm sorry?
[CUSTOMER][NEUTRAL] It's [PII].
[AGENT][NEUTRAL] Your callback number?
[CUSTOMER][NEUTRAL] [PII].
[AGENT][POSITIVE] Thank you and the member's policy number, please, [PII].
[CUSTOMER][NEUTRAL] 02359492 NL 8.
[AGENT][NEUTRAL] OK, that should not be an N, that should be an M.
[CUSTOMER][NEUTRAL] Should be an M. mhm yeah they put here an N, but I guess.
[AGENT][NEUTRAL] OK, so give me just one moment please to get the member's information pulled up.
[CUSTOMER][POSITIVE] Thank you.
[AGENT][NEUTRAL] OK, so any information that I do provide for you today, I would be a verification of benefits and not a guarantee of payment. What is your patient's name and date of birth?
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] [PII], [PII].
[AGENT][POSITIVE] Thank you.
[AGENT][NEUTRAL] OK, so I do show that she is a subscriber on the supplemental policy IV. It is active with an effective date of [PII].
[AGENT][NEUTRAL] And what type of benefit information do you need for her inpatient, outpatient or office?
[CUSTOMER][NEUTRAL] Outpatient.
[AGENT][NEUTRAL] OK, so she has an outpatient benefit max per calendar year for covered outpatient services.
[AGENT][NEUTRAL] Of $1000 and there is no outpatient deductible for covered person per calendar year.
[CUSTOMER][NEUTRAL] So no deductible is covered?
[AGENT][NEUTRAL] Yeah ma'am, that's not what I said. I said that her outpatient benefit maximum for calendar year on this supplemental policy is $1000 for covered services and there is no outpatient deductible per covered person per calendar year.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] OK, has anything been met this year?
[AGENT][NEUTRAL] Oh, I can check. No, ma'am, she has not used any of her benefits as of now.
[AGENT][NEUTRAL] And because this is a supplemental policy IV to the primary insurance, when the claim is submitted to us for review, we will have to have a copy of her primary insurance company's explanation of benefits as well.
[CUSTOMER][NEUTRAL] Mm, OK.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] And then once we have processed our claim we have our portal that you should be able to check our claim status in by going to [PII].
[CUSTOMER][NEUTRAL] OK. Can I get a reference number for the call, please?
[AGENT][NEUTRAL] Yes, ma'am, you would use my name that I gave with today's date.
[CUSTOMER][NEUTRAL] [PII], [PII].
[AGENT][NEUTRAL] Hi. Uh-huh.
[AGENT][POSITIVE] Yes, ma'am. That's it. And can I help you with anything else, [PII]?
[CUSTOMER][NEUTRAL] No, that's all.
[AGENT][POSITIVE] OK. Well, thank you for calling APL and I hope you have a great afternoon.
[CUSTOMER][POSITIVE] Thank you bye bye.
[AGENT][NEUTRAL] Bye-bye.