AccountId: 011433970860
ContactId: f44ae11d-aed6-405a-bf60-134f310b2b7b
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 561859 ms
Total Talk Time (AGENT): 175985 ms
Total Talk Time (CUSTOMER): 119204 ms
Interruptions: 5
Overall Sentiment: AGENT=1.1, CUSTOMER=1.1
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/01/23/f44ae11d-aed6-405a-bf60-134f310b2b7b_20250123T13:36_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] Yes, I need to verify benefits for a patient. Can I put you on a brief hold though because I have another patient in front of me.
[AGENT][NEUTRAL] Uh, yes, ma'am.
[CUSTOMER][POSITIVE] Thank you so much.
[CUSTOMER][NEUTRAL] Sorry about that hold. OK, so I need to verify um benefits for a patient of ours.
[AGENT][NEUTRAL] OK. Do you also need eligibility or strictly benefits?
[CUSTOMER][NEUTRAL] Uh, both.
[AGENT][POSITIVE] Yes, ma'am. I can help you with that. And who am I speaking with?
[CUSTOMER][NEUTRAL] [PII] from Suncoast Women's Care.
[AGENT][NEUTRAL] Thank you and [PII], what is your callback number, please?
[CUSTOMER][NEUTRAL] It is [PII].
[AGENT][POSITIVE] Thank you. And the member's policy number pleased on you.
[CUSTOMER][NEUTRAL] It is 02021826.
[AGENT][POSITIVE] Thank you, one moment.
[CUSTOMER][POSITIVE] Good morning
[CUSTOMER][POSITIVE] Good.
[CUSTOMER][NEUTRAL] Yes
[CUSTOMER][NEUTRAL] Mhm
[AGENT][NEUTRAL] OK, and tell you, any information that I do provide for you today will be a verification of benefits and not a guarantee of payment. What is your patient's name and date of birth?
[CUSTOMER][NEUTRAL] Patient's name and date of birth is [PII]. Date of birth [PII].
[AGENT][POSITIVE] Thank you.
[CUSTOMER][NEUTRAL] Oh got you OK.
[CUSTOMER][NEUTRAL] That's OK, yeah, because the lab is considered like a.
[AGENT][NEUTRAL] OK, so I do say she is a dependent on the supplemental policy and the supplemental policy is active. What's an effective date of [PII].
[CUSTOMER][NEUTRAL] Yeah.
[AGENT][NEUTRAL] And what type of benefit information do you need for her inpatient, outpatient or office?
[CUSTOMER][NEUTRAL] Oh
[CUSTOMER][NEUTRAL] I would say office maternity, maternity. She's pregnant.
[AGENT][NEUTRAL] OK, so there are no benefits on this policy for office visits?
[AGENT][NEUTRAL] If she receives uh treatment within the office, there is a, she does have a treatment writer on here in which we could review benefits under her outpatient, and that outpatient benefit maximum is $800 per covered person per calendar day.
[CUSTOMER][NEUTRAL] Yes.
[AGENT][NEUTRAL] For covered outpatient services.
[CUSTOMER][NEUTRAL] Could I give you a code and you tell me if it's covered or not?
[AGENT][NEUTRAL] No, ma'am, because this fall, we would have to receive her primary insurance company's explanation of benefits.
[AGENT][NEUTRAL] Prior to, I mean, to review the claim.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] So along with any claim on this type of policy.
[CUSTOMER][NEUTRAL] So she would have to hit that 800. Mhm.
[AGENT][NEUTRAL] That's the maximum benefit this policy would pay for a covered outpatient service per calendar day.
[CUSTOMER][NEUTRAL] Outpatient service.
[AGENT][NEUTRAL] And again, office visits are not covered.
[CUSTOMER][NEUTRAL] Mhm and then.
[AGENT][NEUTRAL] And give me just a moment to look at something else.
[CUSTOMER][POSITIVE] Mhm, no problem, thank you.
[AGENT][NEUTRAL] On this policy. Thank you. Uh-huh.
[AGENT][NEUTRAL] I apologize about the delay. It's just taking a moment for my system to.
[CUSTOMER][POSITIVE] Yeah, no worries. I know all about that, that's for sure.
[AGENT][NEUTRAL] Lead some information.
[AGENT][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] And you said that that $800 was covered per person for this and it was an outpatient services, not inpatient?
[AGENT][NEUTRAL] This is not impatient and I'm looking at something else on here.
[CUSTOMER][NEUTRAL] OK, OK, OK.
[CUSTOMER][POSITIVE] Oh, I like her jacket.
[CUSTOMER][NEUTRAL] I need to get one like that, that purply.
[CUSTOMER][NEUTRAL] But you know she comes from [PII] so you know that she knows how to.
[AGENT][NEUTRAL] OK. So on, on this supplemental policy, I just checked, [PII], pregnancy of an elig eligible dependent is excluded completely on this policy.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Gotcha. That's really all I need to, so it doesn't, yeah, she's pregnant. Mhm.
[AGENT][NEUTRAL] The maternity is, you did say I was gonna say, I, I wanna just clarify, you did say she was pregnant. Is that correct? Yes, it does state in their policy that pregnancy of an eligible dependent child isn't, is an exclusion.
[CUSTOMER][NEUTRAL] Mhm, yes ma'am.
[CUSTOMER][NEUTRAL] Alright, and can I have a reference number for this call, please?
[AGENT][NEUTRAL] Sure, you would use my name along with today's date and so you just for future reference in case you will ever do, you know, do file a claim with us remember, um, we also have a portal that you should be able to access claim status in once we process the claim, and that website is [PII].
[CUSTOMER][NEUTRAL] You.
[CUSTOMER][NEUTRAL] Mm.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Yeah, I see that in the back of the card. OK, perfect. And what was your name?
[AGENT][NEUTRAL] OK. Mhm. OK.
[AGENT][NEUTRAL] My name is [PII] and my name along with today's date, uh-huh.
[CUSTOMER][NEUTRAL] [PII].
[CUSTOMER][POSITIVE] All right, thank you so much for the information.
[AGENT][POSITIVE] Well, you are certainly very welcome. So if that is all I can help you with, [PII], thank you again for calling APL and I hope you have a wonderful day.
[CUSTOMER][NEUTRAL] Yes, ma'am.
[CUSTOMER][POSITIVE] Alright thank you bye bye.
[AGENT][NEUTRAL] Yes, ma'am. Bye-bye