AccountId: 011433970860
ContactId: f1d6ffb3-dd43-495c-95a4-bfb2332b759e
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 254080 ms
Total Talk Time (AGENT): 135501 ms
Total Talk Time (CUSTOMER): 108837 ms
Interruptions: 3
Overall Sentiment: AGENT=1.3, CUSTOMER=0.8
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/02/06/f1d6ffb3-dd43-495c-95a4-bfb2332b759e_20250206T13:55_UTC.wav
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[CUSTOMER][NEUTRAL] I'm
[AGENT][POSITIVE] Good morning. Thank you for calling APL. This is [PII]. How can I help you?
[CUSTOMER][NEUTRAL] Hi [PII], this is [PII]. I'm calling from South Florida ENT. I'm calling to check the eligibility and benefits for a patient.
[AGENT][NEUTRAL] OK, [PII], you're needing eligibility and benefits, is that correct?
[CUSTOMER][NEUTRAL] Yes ma'am.
[AGENT][POSITIVE] Yes ma'am, I can help you with that. And what is your callback number, please?
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] Thank you. And the member's policy number, please?
[CUSTOMER][NEUTRAL] The policy number is 02216520 M for Mary, L for Lima and the number 8.
[CUSTOMER][NEUTRAL] pe
[AGENT][POSITIVE] Thank you, one moment.
[CUSTOMER][NEUTRAL] Mm.
[CUSTOMER][NEUTRAL] OK
[AGENT][NEUTRAL] And any information [PII] that I provide for you would be a verification of benefits and not a guarantee of payment. Uh, what is your patient's name please and date of birth?
[CUSTOMER][NEUTRAL] The name is the last name is [PII] First name [PII] [PII] The date of birth is [PII].
[AGENT][POSITIVE] OK, thank you.
[CUSTOMER][POSITIVE] It's a good color.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] OK, so I do see that he is a subscriber on the supplemental policy, [PII]. It is active with an effective date of [PII].
[AGENT][NEUTRAL] And were you needing inpatient, outpatient or office benefits?
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Um, everything, I just need to know what they cover.
[AGENT][NEUTRAL] For what type of service, inpatient, outpatient or office?
[CUSTOMER][NEUTRAL] Like I need to know if their office, it's uh inpatient. I need to know if their office visits are covered uh if their office procedures are covered up to how much and how much is remaining of that.
[AGENT][NEUTRAL] Yeah.
[AGENT][NEUTRAL] OK, so you said inpatient, so the patient has been admitted as an inpatient into the hospital?
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][POSITIVE] No, then outpatient. I'm sorry.
[AGENT][NEUTRAL] OK, so the policy does have an office treatment writer on it. Office visits are not covered. The outpatient benefit max per calendar day for covered outpatient services is $200.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Yeah
[AGENT][NEUTRAL] And there is no outpatient benefit. I'm sorry, there's no outpatient deductible per cover person per calendar day because this is a supplemental policy just to the primary insurance when the claim is submitted to APL, we must also receive a copy of the primary insurance company's explanation of excuse me, explanation of benefits.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] We have
[CUSTOMER][NEUTRAL] Pharmacy
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] OK
[CUSTOMER][NEUTRAL] I have to walk on 96.
[CUSTOMER][NEUTRAL] I mean, 96, 75.
[AGENT][NEUTRAL] For review as well and then once we have processed our claim, you may check our claim status by going to our portal at [PII].
[CUSTOMER][NEUTRAL] OK, and I'm sorry, [PII], did you say it was up to 200?
[AGENT][NEUTRAL] It's [PII].
[AGENT][NEUTRAL] Yeah, my name is [PII].
[CUSTOMER][NEUTRAL] oh [PII], I'm sorry. I even, I'm sorry. I even wrote [PII]. I think the, the previous agent was [PII]. I'm sorry. You said it was up to 200?
[AGENT][NEUTRAL] That's OK.
[AGENT][NEUTRAL] The outpatient benefit maximum per calendar day for covered outpatient services is 200.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Per day, OK perfect and I'm assuming that none of that has been used today, right?
[AGENT][NEUTRAL] We do not have a claim on file for the member for date of service of [PII] at this time.
[CUSTOMER][NEUTRAL] OK perfect [PII], can I please have a reference number for the call?
[AGENT][NEUTRAL] You would use my name along with today's date.
[CUSTOMER][POSITIVE] Alrighty perfect thank you so much for your help. I hope you have a great rest of the week.
[AGENT][NEUTRAL] Alright, will you.
[AGENT][POSITIVE] Yes ma'am, I hope you do too, and thank you again for calling APL [PII].
[AGENT][POSITIVE] If that's all I can help you with. You're welcome.
[CUSTOMER][POSITIVE] Thank you bye bye. Yes, that's all thank you, bye.
[AGENT][NEUTRAL] OK, bye bye.