AccountId: 011433970860
ContactId: f1a42e5a-77e5-4a7d-ac9d-59672ffd41f8
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 368149 ms
Total Talk Time (AGENT): 174737 ms
Total Talk Time (CUSTOMER): 107115 ms
Interruptions: 1
Overall Sentiment: AGENT=1.3, CUSTOMER=1.5
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/06/10/f1a42e5a-77e5-4a7d-ac9d-59672ffd41f8_20250610T16:36_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 was wondering if you could assist me in verifying a patient if they're currently using APL with you guys, um, as well as if they have an outpatient annual amount that you provide to assist in any co-pays they have.
[AGENT][NEUTRAL] OK, so you're needing to verify eligibility and outpatient benefits for a member, is that correct?
[CUSTOMER][POSITIVE] Correct.
[AGENT][POSITIVE] Yes, ma'am. I can help you with those things. And who am I speaking with, please?
[CUSTOMER][NEUTRAL] My name is [PII]. Last name [PII].
[AGENT][NEUTRAL] OK, [PII], and my last initial is also [PII] And what is your callback number, please?
[CUSTOMER][NEUTRAL] My callback number is [PII]. I have no extension.
[AGENT][NEUTRAL] Thank you. And what is the member's policy number?
[CUSTOMER][NEUTRAL] Um, the policy number that I have here is 01823016, M, L, and the number 8.
[AGENT][NEUTRAL] OK, thank you [PII], one moment while I get the member's information pulled up.
[CUSTOMER][NEUTRAL] Sure.
[AGENT][NEUTRAL] OK, [PII], any information that I provide will be a verification of benefits and not a guarantee of payment. What is your patient's name and date of birth?
[CUSTOMER][NEUTRAL] Um, I have, well, I have, I probably have both people under the plan, but I have [PII]. Um, date of birth [PII], as well as his wife, Ms. [PII]. Date of birth [PII].
[AGENT][NEUTRAL] OK. Who's your patient?
[CUSTOMER][NEUTRAL] Both.
[AGENT][NEUTRAL] OK, one moment.
[CUSTOMER][NEUTRAL] Mhm, I apologize they're coming in at the same time. I just wanted to verify so.
[AGENT][NEUTRAL] OK, one moment.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] OK, so first off, [PII], um, on the policy number that you provided for me, that is an old policy number that's no longer active. That policy actually had a termination date of [PII].
[CUSTOMER][NEUTRAL] Oh, I see.
[AGENT][NEUTRAL] But there is another policy that is active with a different policy number.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] The current active policy is going to be 02134933.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] And it has an effective date of [PII].
[CUSTOMER][NEUTRAL] OK, and this, and this policy number is current, correct? They're still using this one?
[AGENT][NEUTRAL] 021 34933.
[CUSTOMER][NEUTRAL] Yes, for both of them, right?
[AGENT][POSITIVE] Yes, ma'am, that is correct. She is the spouse of the subscriber.
[CUSTOMER][POSITIVE] OK perfect
[AGENT][NEUTRAL] And what type of benefit information again do you need inpatient, outpatient or office?
[CUSTOMER][POSITIVE] Perfect.
[CUSTOMER][NEUTRAL] Um, outpatient. They're coming in for an echo.
[AGENT][NEUTRAL] OK, so the outpatient benefit maximum is a per calendar day benefit. So the outpatient benefit max per calendar day for covered outpatient services is $1500 per covered person with no outpatient deductible per covered person per calendar day.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] OK, so it's per calendar day, OK.
[AGENT][POSITIVE] Correct, that is correct. Now, because.
[CUSTOMER][NEUTRAL] And it and it that that that means that it replenishes every day, correct?
[AGENT][NEUTRAL] I'm so sorry. What was your question again, [PII]?
[CUSTOMER][NEUTRAL] Sorry, I'm just trying to to get uh an understanding. So per calendar day just means that every day it replenishes if they, if they've used it the day prior, correct?
[AGENT][NEUTRAL] Correct, it's not a per calendar year benefit. This one is a per calendar day.
[CUSTOMER][POSITIVE] Oh OK, perfect. OK.
[AGENT][NEUTRAL] OK, and then because it is a supplement to the primary insurance when the claim is submitted to APL or claims or submitted to us for review, we will also need a copy of the primary insurance company's explanation of benefits with the claim.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] And then once we have processed the claims here at APL we do have a portal that you should be able to check claim status in for them and the website that you would go to for our portal is located at secured.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] [PII]
[AGENT][NEUTRAL] [PII].
[CUSTOMER][NEUTRAL] Mhm
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][POSITIVE] Perfect. OK.
[AGENT][NEUTRAL] OK.
[CUSTOMER][POSITIVE] Already. OK, thank you so much, Ms. [PII].
[AGENT][POSITIVE] All right. Well, is there, you are so very welcome. Is there anything else that I can help you with today?
[CUSTOMER][NEUTRAL] Um, no, you've answered all of my questions. I think just the reference number.
[AGENT][NEUTRAL] You would use my name along with today's date.
[CUSTOMER][POSITIVE] Perfect, thank you again Miss [PII]. I really appreciate it.
[AGENT][POSITIVE] Yes. Oh, well, you're very welcome. It was my pleasure in speaking to you today, [PII], and I hope you have a wonderful rest of your day.
[CUSTOMER][POSITIVE] Thank you you as well.
[AGENT][POSITIVE] Yes, ma'am. Thank you.
[AGENT][NEUTRAL] Bye-bye.
[CUSTOMER][NEUTRAL] Bye bye now.