AccountId: 011433970860
ContactId: f1166e24-8bb9-4b9e-a730-e48dde04a8da
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 288790 ms
Total Talk Time (AGENT): 154192 ms
Total Talk Time (CUSTOMER): 51083 ms
Interruptions: 2
Overall Sentiment: AGENT=2.1, CUSTOMER=3.1
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/05/05/f1166e24-8bb9-4b9e-a730-e48dde04a8da_20250505T12:03_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], my name is [PII]. I'm calling to get benefits and eligibility on a patient please.
[AGENT][NEUTRAL] OK, for like, you're needing benefits and eligibility. Is that correct?
[CUSTOMER][POSITIVE] That is correct, yes.
[AGENT][POSITIVE] Yes, ma'am. I can help you with those things. And [PII], what is a good callback number for you, please?
[CUSTOMER][NEUTRAL] [PII]
[AGENT][POSITIVE] Thank you.
[AGENT][NEUTRAL] And what is the member's policy number, please?
[CUSTOMER][NEUTRAL] Policy number I have on file is 0194.
[CUSTOMER][NEUTRAL] 3994 M like Mary L like Larry number 8.
[AGENT][POSITIVE] OK, thank you, give me a couple of moments please to get the member's information pulled up.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][POSITIVE] Thank you.
[AGENT][NEUTRAL] OK, and any, again, any information provided would be a verification of benefits and not a guarantee of payment. What is your patient's name and their date of birth?
[CUSTOMER][NEUTRAL] It is [PII]. Date of birth [PII].
[AGENT][NEUTRAL] OK, thank you. Now, on the policy number that you gave me, she had been the spouse of the subscriber, but this policy was active from [PII].
[AGENT][NEUTRAL] To [PII]. Let me see if there is another policy, yes, you have, you
[AGENT][NEUTRAL] Yes, give me just a second to get the current policy information pulled up.
[CUSTOMER][POSITIVE] OK perfect thank you.
[AGENT][POSITIVE] You're welcome.
[AGENT][NEUTRAL] OK, so the correct policy number that you should have for the policy that is active is 025564.
[AGENT][NEUTRAL] 58.
[AGENT][NEUTRAL] And this policy has an effective date of [PII].
[AGENT][NEUTRAL] And what type of benefit information again do you need inpatient, outpatient or office?
[CUSTOMER][NEUTRAL] Outpatient please.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] OK, so the outpatient benefit maximum per calendar year per covered person for covered outpatient services is $8700.
[AGENT][NEUTRAL] And there is no outpatient deductible per covered person per calendar year.
[AGENT][NEUTRAL] Because this is a supplement. I'm so sorry. Go ahead. OK, so because this is a
[CUSTOMER][NEUTRAL] OK, does anything.
[CUSTOMER][NEUTRAL] Mhm go ahead.
[CUSTOMER][NEUTRAL] Oh no I was just asking, has anything been met towards it?
[AGENT][NEUTRAL] I can check that.
[CUSTOMER][POSITIVE] Thank you.
[AGENT][POSITIVE] You're welcome.
[AGENT][NEGATIVE] As of now, no, ma'am. There has not been any benefits used for this calendar year.
[CUSTOMER][POSITIVE] OK perfect.
[AGENT][NEUTRAL] And then what I was gonna say is because it is a supplement to the primary insurance, when the claim is filed with us for review, we will also have to have a copy of a primary insurance company's explanation of benefits.
[AGENT][NEUTRAL] And then once we've processed our claim here at APL, we do have a portal [PII] in which you should be able to check our claim status and the website for that is secured. [PII].
[CUSTOMER][POSITIVE] OK perfect.
[CUSTOMER][POSITIVE] OK perfect all right, we should be good to go then thank you so much for your help. Nope, that would be all [PII] thank you.
[AGENT][NEUTRAL] OK. Was there anything else?
[AGENT][POSITIVE] Well, you are certainly very welcome. Can I help you?
[AGENT][POSITIVE] Well, you're welcome and thank you again for calling APL. I hope you have a wonderful day.
[CUSTOMER][POSITIVE] Thank you you as well goodbye.
[AGENT][POSITIVE] Thank you. Bye bye.