AccountId: 011433970860
ContactId: f566409a-757a-4ed6-89cd-a45b6aaa63cc
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 333040 ms
Total Talk Time (AGENT): 156257 ms
Total Talk Time (CUSTOMER): 81247 ms
Interruptions: 0
Overall Sentiment: AGENT=1.4, CUSTOMER=0.5
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/05/28/f566409a-757a-4ed6-89cd-a45b6aaa63cc_20250528T17:33_UTC.wav
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[AGENT][NEUTRAL] And thank you for calling APL. This is [PII]. How can I help you?
[CUSTOMER][NEUTRAL] Hi, good day. I'm calling from a facility I'd like to be, um, verify a patient's benefits.
[AGENT][NEUTRAL] OK, are you also needing eligibility or strictly just benefit information?
[CUSTOMER][NEUTRAL] Um, both.
[AGENT][POSITIVE] Yes, ma'am. I can help you with this. And first off, who am I speaking with?
[CUSTOMER][NEUTRAL] My name is [PII], which is [PII]
[AGENT][NEUTRAL] Thank you and [PII], what is your callback number?
[CUSTOMER][NEUTRAL] [PII]
[AGENT][POSITIVE] Thank you. And the member's policy number, please.
[CUSTOMER][NEUTRAL] Policy number is going to be 02503212.
[AGENT][NEUTRAL] OK, [PII], thank you. Give me a moment please to get the member's information pulled up.
[CUSTOMER][POSITIVE] No problem.
[AGENT][POSITIVE] Thank you.
[AGENT][NEUTRAL] And I'm so sorry, [PII]. Did you say that you did or did not need eligibility?
[CUSTOMER][NEUTRAL] I needed it as well.
[AGENT][NEUTRAL] OK, yes ma'am. OK. I thought that's what you said, but I just wanted to confirm it. OK.
[CUSTOMER][NEUTRAL] But yes mhm.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] And any information that I do 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] First name is [PII]. Last name is [PII]. Do you need me to spell it or just state?
[AGENT][NEUTRAL] No, that's fine. And date of birth?
[CUSTOMER][NEUTRAL] Um, date of birth [PII].
[AGENT][NEUTRAL] OK, thank you. So I do show that he is a subscriber on the supplemental policy, and the supplemental policy is active with an effective date of [PII].
[AGENT][NEUTRAL] [PII].
[AGENT][NEUTRAL] And are you needing inpatient, outpatient or office benefits?
[CUSTOMER][NEUTRAL] Inpatient and um if there's any ER.
[AGENT][NEUTRAL] OK, one moment.
[AGENT][NEUTRAL] And you did say that he has been admitted as an inpatient?
[CUSTOMER][NEUTRAL] Yeah, he was admitted. It, um, it's a past visit. He just gave me the additional insurance yesterday.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] OK, so is the inpatient benefit maximum per calendar year is $3000 with no outpatient deductible.
[AGENT][NEUTRAL] And the outpatient benefit maximum for the ER is 1500 per covered person per calendar year.
[AGENT][NEUTRAL] With no deductible.
[CUSTOMER][NEUTRAL] And you said that was 1500?
[AGENT][NEUTRAL] On outpatient and for inpatient, it's 3000. That is correct, yes ma'am.
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] OK, [PII], OK.
[AGENT][NEUTRAL] Now, because this is a supplemental policy to his primary insurance, [PII], when the claim is submitted to us for review, we will have to also receive a copy of the primary insurance company's explanation of benefits.
[AGENT][NEUTRAL] As well as the claim and then once we have processed our claim here we do have a portal that you should be able to check our claim status in by going to [PII].
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] OK, well, is there anything else that I could help you with?
[CUSTOMER][NEUTRAL] Um, would you need that information faxed over, or how would you send that information about the primary insurance's, um, claim information?
[AGENT][NEUTRAL] You would send the claim and the primary insurance company's explanation of benefits just for review.
[CUSTOMER][NEUTRAL] Via fax?
[AGENT][NEUTRAL] It can be faxed. Both of them can be faxed to [PII]. Attention claims department.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Um, can I have your name please?
[AGENT][NEUTRAL] Again, my name is [PII] and my name and today's date will be your call reference number.
[CUSTOMER][POSITIVE] OK, alright, thank you so much, Miss [PII].
[AGENT][POSITIVE] Well, you're welcome. And is there anything else I can help you with today, [PII]?
[CUSTOMER][NEUTRAL] No, that's it.
[AGENT][POSITIVE] OK, well, thank you so much then for calling APL and I hope you have a nice afternoon.
[CUSTOMER][POSITIVE] Thank you and same to you.
[AGENT][POSITIVE] Yes, ma'am. Thank you. Bye-bye.
[CUSTOMER][NEUTRAL] Bye.