AccountId: 011433970860
ContactId: f382161e-a2b7-4f0f-91f7-ce977eef43ee
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 283450 ms
Total Talk Time (AGENT): 124430 ms
Total Talk Time (CUSTOMER): 79988 ms
Interruptions: 2
Overall Sentiment: AGENT=1.3, CUSTOMER=0.7
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/04/25/f382161e-a2b7-4f0f-91f7-ce977eef43ee_20250425T14:31_UTC.wav
--------------------------------------------
[AGENT][NEUTRAL] Thank you for calling APL. This is [PII]. How can I help you?
[CUSTOMER][NEUTRAL] Hi, [PII]. Um, good good morning. My name is [PII]. I'm calling to verify a patient's eligibility.
[AGENT][NEUTRAL] OK. Did you say that your name is [PII]?
[CUSTOMER][NEUTRAL] Yes.
[AGENT][NEUTRAL] OK, [PII], and you're only needing eligibility information, is that correct for a number?
[CUSTOMER][NEUTRAL] Um, let me see, yes, correct, just the eligibility.
[AGENT][POSITIVE] Yes, I can help you with that, [PII]. And what is a good callback number for you please?
[CUSTOMER][NEUTRAL] It's [PII].
[CUSTOMER][NEUTRAL] [PII]
[CUSTOMER][NEUTRAL] [PII].
[AGENT][POSITIVE] Thank you. And the member's policy number, please.
[CUSTOMER][NEUTRAL] Member's policy number is 02606954 M as in Mike L as in Lima 8.
[AGENT][NEUTRAL] OK thank you one moment please while I get the member's information pulled up.
[CUSTOMER][NEUTRAL] Mhm
[CUSTOMER][POSITIVE] Thank you.
[AGENT][POSITIVE] You're welcome.
[AGENT][NEUTRAL] And any information [PII] 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] Mhm.
[CUSTOMER][NEUTRAL] Patient's name is [PII]. Date of birth is [PII].
[AGENT][NEUTRAL] OK, and I'm sorry, what was the first name again?
[CUSTOMER][NEUTRAL] Um, [PII].
[AGENT][POSITIVE] OK, thank you.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] I do show that she is the spouse of the subscriber on this supplemental policy, [PII], and this policy is active with an effective date of [PII].
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] Now if there's a way that you can make a note.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] That on this policy, because it is a supplement to their primary insurance, when a claim is filed with APL, we will also have to have a copy of the primary insurance company's explanation of benefits.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] As well.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] And then once we have processed our claim here at APL we have a portal in which you should be able to check claim status.
[AGENT][NEUTRAL] And that portal website is secured. [PII].
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][POSITIVE] OK, perfect, noted.
[AGENT][NEUTRAL] OK. And is there anything else that I can help you with?
[CUSTOMER][NEUTRAL] Um, let me see, tracing.
[CUSTOMER][NEUTRAL] Mhm. Yes, um, there's one thing, um, by any chance, can you, can you tell me how this patient has um two, let me see, 2 exams for an ultrasound. Will you be able to know if, um, how much does the patient have um available for this type of exam?
[AGENT][NEUTRAL] OK, so you're needing outpatient benefits, is that correct?
[CUSTOMER][NEUTRAL] Mhm. Yes.
[AGENT][NEUTRAL] OK, one moment.
[AGENT][NEUTRAL] OK, so on the supplemental policy cabin for covered outpatient services, the benefit maximum is $8700.
[AGENT][NEUTRAL] Per calendar year.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] And there is no outpatient deductible per cover person per calendar year.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][POSITIVE] OK, perfect.
[AGENT][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] Um, has the patient meant anything?
[CUSTOMER][NEUTRAL] I don't know.
[AGENT][NEUTRAL] Uh, one moment.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEGATIVE] As of now, no benefits have been used.
[CUSTOMER][NEUTRAL] OK perfect thank you [PII] um can I get a reference number for the call?
[AGENT][POSITIVE] Yes, you will actually use my name along with today's date.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][POSITIVE] OK perfect. OK, [PII] thank you so much that will be all.
[AGENT][NEUTRAL] All right. Well, is there anything else?
[AGENT][POSITIVE] You're welcome. OK, [PII]. Well, that's all I can help you with. Thank you again for calling APL and I hope you have a great weekend.
[CUSTOMER][NEUTRAL] No.
[CUSTOMER][NEUTRAL] Mhm
[CUSTOMER][POSITIVE] You too, thank you so much.
[AGENT][POSITIVE] Uh-huh. Thank you also. Bye-bye.