AccountId: 011433970860
ContactId: f1d0048c-2070-4775-bdb3-4a75b7bef5fb
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 217169 ms
Total Talk Time (AGENT): 108631 ms
Total Talk Time (CUSTOMER): 47957 ms
Interruptions: 0
Overall Sentiment: AGENT=2, CUSTOMER=1.4
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/05/05/f1d0048c-2070-4775-bdb3-4a75b7bef5fb_20250505T17:36_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] Hi [PII], my name is [PII] calling from Jackson West Medical Center. I have a, a patient coming for outpatient procedure, and I would like to obtain the benefit, please.
[AGENT][NEUTRAL] Yes, ma'am.
[AGENT][NEUTRAL] OK. Well, you're needing benefits for outpatient. Is that correct? Yes, ma'am, I can help you with that. And I, what is your callback number?
[CUSTOMER][NEUTRAL] Mhm. Yes.
[CUSTOMER][NEUTRAL] [PII]
[AGENT][NEUTRAL] Thank you. And what is the member's policy number, please?
[CUSTOMER][NEUTRAL] 01725691
[CUSTOMER][NEUTRAL] M as in Mary, L as in Larry, number 8.
[AGENT][NEUTRAL] OK, thank you. And also, do you also need eligibility or strictly just benefits?
[CUSTOMER][NEUTRAL] Eligibility as well, please.
[AGENT][NEUTRAL] You need eligibility as well?
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] And any information Olga that I do provide for you will be a verification of benefits and not a guarantee of payment. What is your patient's name please and date of birth?
[CUSTOMER][NEUTRAL] Patient name is [PII]. Date of birth [PII].
[AGENT][POSITIVE] OK, thank you.
[AGENT][NEUTRAL] OK, so I do show she is the spouse of the subscriber on the supplemental policy and her effective date is [PII].
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][POSITIVE] And give me one moment and I'll provide you the benefit information.
[CUSTOMER][POSITIVE] Thank you.
[AGENT][POSITIVE] You're welcome.
[AGENT][NEUTRAL] OK, so on the supplemental plan, the outpatient benefit maximum per calendar year for covered outpatient services is $2500 with no outpatient deductible per covered person per calendar year.
[AGENT][NEGATIVE] And as of now, she has not used any benefits for this calendar year.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][POSITIVE] Oh gosh, you have all the benefits. OK. OK, [PII], could I have any single last name, please?
[AGENT][NEUTRAL] It's [PII] and just a couple of additional things I'll go well first off you're gonna use my name along with today's date as your reference number. Then when the claim is filed with APL we will have to have a copy of our primary insurance company's explanation of benefits as well. And then lastly, once we process our claim, you should be able to check claim status in our portal which is located at [PII].
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][POSITIVE] OK, thank you for your help, [PII].
[AGENT][POSITIVE] Well, you're very welcome. And can I help you with anything else today?
[CUSTOMER][POSITIVE] Mm that would be, thank you.
[AGENT][POSITIVE] OK. Well, thank you for calling APL and I hope you have a great afternoon.
[CUSTOMER][NEUTRAL] Likewise then, bye bye.
[AGENT][POSITIVE] Thank you. Bye bye.
[CUSTOMER][NEUTRAL] Mhm.