AccountId: 011433970860
ContactId: f234ce3e-d6e2-4ee9-b790-a8ced22e4762
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 188960 ms
Total Talk Time (AGENT): 90079 ms
Total Talk Time (CUSTOMER): 42925 ms
Interruptions: 0
Overall Sentiment: AGENT=2.1, CUSTOMER=3.2
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/01/23/f234ce3e-d6e2-4ee9-b790-a8ced22e4762_20250123T14:54_UTC.wav
--------------------------------------------
[AGENT][POSITIVE] Good morning. Thank you for calling APL. This is [PII]. How can I help you?
[CUSTOMER][NEUTRAL] Hey, [PII], um, my name is [PII]. I'm from Upstate Maternal fetal medicine. Just calling to verify eligibility for a patient.
[AGENT][NEUTRAL] OK, [PII], so you're just needing to verify eligibility and not benefit information, is that correct?
[CUSTOMER][POSITIVE] And a benefit too, yeah, maternity benefit.
[AGENT][NEUTRAL] OK, yes ma'am, I can help you. And what is your callback number please, [PII]?
[CUSTOMER][NEUTRAL] Mhm [PII].
[CUSTOMER][NEUTRAL] [PII]
[AGENT][POSITIVE] Thank you and the member's policy number, please.
[CUSTOMER][NEUTRAL] Policy number is 02512553.
[AGENT][POSITIVE] Thank you. One moment.
[AGENT][NEUTRAL] OK, and any information that I do provide for you today, [PII] 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] Uh patient's name, uh last name is [PII] First name is [PII] Date of birth [PII].
[AGENT][NEUTRAL] Mhm.
[AGENT][NEUTRAL] OK, thank you. So I do see that she is a subscriber on the supplemental policy and the supplemental policy is active. What's an effective date of [PII].
[AGENT][NEUTRAL] 4
[AGENT][NEUTRAL] And again, are you needing inpatient, outpatient or office benefits?
[CUSTOMER][NEUTRAL] Uh, outpatient.
[AGENT][NEUTRAL] OK, so she has an outpatient benefit maximum for covered outpatient services per calendar year of $2000 and there is no outpatient deductible per covered person per calendar year.
[CUSTOMER][POSITIVE] Got you alrighty thank you so much.
[AGENT][NEUTRAL] And yes ma'am, and just a couple of additional things [PII], when a claim is submitted to us for review, we must also have a copy of her primary insurance company's explanation of benefits.
[AGENT][NEUTRAL] And then also once our claim has been processed, you may check claim status by going to our portal at [PII].
[CUSTOMER][POSITIVE] Alright, thank you.
[AGENT][POSITIVE] You're very welcome. And is there anything else that I can help you with today?
[CUSTOMER][POSITIVE] Uh, that's it. Have a good one.
[AGENT][POSITIVE] OK, you too, [PII], and thank you again for calling APL.
[CUSTOMER][POSITIVE] Thank you bye bye.