AccountId: 011433970860
ContactId: ee84bf2a-0254-4608-af9d-70c979bdf5ae
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 286880 ms
Total Talk Time (AGENT): 139059 ms
Total Talk Time (CUSTOMER): 67053 ms
Interruptions: 1
Overall Sentiment: AGENT=1.7, CUSTOMER=1.4
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/05/12/ee84bf2a-0254-4608-af9d-70c979bdf5ae_20250512T14:42_UTC.wav
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[AGENT][POSITIVE] Good morning. Thank you for calling APL. This is [PII]. How can I help you?
[CUSTOMER][NEUTRAL] Hi [PII], I am trying to see if um you can help me with benefits and eligibility.
[AGENT][NEUTRAL] OK, you have one patient that you're needing eligibility and benefits on, is that correct?
[CUSTOMER][POSITIVE] Correct.
[AGENT][POSITIVE] Yes ma'am, I can help you with that and who am I speaking with please?
[CUSTOMER][NEUTRAL] It's [PII].
[AGENT][POSITIVE] OK, thank you. And [PII], what is a good callback number for you?
[CUSTOMER][NEUTRAL] [PII]
[AGENT][NEUTRAL] Thank you and the member's policy number please, [PII]?
[CUSTOMER][NEUTRAL] Mhm
[CUSTOMER][NEUTRAL] Uh, yes, it is. Oh, I hope I didn't get rid of it. Give me one second.
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] 02096469
[AGENT][NEUTRAL] OK, thank you. One moment please while I get the um information pulled up.
[CUSTOMER][NEUTRAL] Uh huh.
[CUSTOMER][POSITIVE] Yes ma'am thank you.
[AGENT][POSITIVE] You're welcome.
[CUSTOMER][NEUTRAL] 24
[CUSTOMER][NEUTRAL] 5073124.
[CUSTOMER][NEUTRAL] Mhm mhm.
[AGENT][NEUTRAL] And [PII], any information that is provided 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] Um, [PII], date of birth [PII].
[AGENT][NEUTRAL] OK, thank you. So yes, ma'am, I do show she is the subscriber on the supplemental policy and it is active effective [PII].
[AGENT][NEUTRAL] And what type of benefit information do you need for her inpatient, outpatient or office?
[CUSTOMER][NEUTRAL] Outpaced, no, no, I'm so sorry, emergency room.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] OK, so that's considered still outpatient, so there is.
[AGENT][NEUTRAL] Uh, I'm sorry, her outpatient benefit maximum per calendar year for covered outpatient services is gonna be $2550 with no deductible.
[CUSTOMER][NEUTRAL] OK, and has anything been used?
[AGENT][NEUTRAL] One moment and I can check that for you.
[CUSTOMER][NEUTRAL] Uh.
[AGENT][NEUTRAL] Well, just a moment.
[AGENT][NEGATIVE] My system is not cooperating. There we go. OK, so as of now I show that $10 has been used.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] OK perfect and is an authorization, no right? it's not required.
[AGENT][NEUTRAL] No, there is no prior authorization since this is a supplemental policy. However, when the claim is submitted to us for review, we must receive a copy of her primary insurance company's explanation of benefits with the claim.
[AGENT][NEUTRAL] And then once we have processed the claim here at APL [PII] we have a portal in which you should be able to check claim status by going to secured. [PII].
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Yeah
[CUSTOMER][NEUTRAL] And uh let's see.
[CUSTOMER][NEUTRAL] Let me just confirm I have the claims address as [PII].
[AGENT][NEUTRAL] That is correct. And the zip code is, do you have that?
[AGENT][NEUTRAL] It's [PII].
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][POSITIVE] Yes ma'am, that is correct. Attention claims department. Well, you're welcome. So again, is there anything else I could help you with today?
[CUSTOMER][POSITIVE] OK perfect well thank you so much.
[CUSTOMER][POSITIVE] Uh, no, thank you so much, [PII].
[AGENT][POSITIVE] You're welcome. Yes, ma'am, absolutely. So if that is all I could help you with, it was my pleasure in speaking to you and thank you again for calling APL. I hope you have a wonderful day.
[CUSTOMER][POSITIVE] Have a great week thank you.
[AGENT][POSITIVE] Yes, ma'am. Thank you too.
[AGENT][NEUTRAL] Bye bye.