AccountId: 011433970860
ContactId: f8a0d3ae-74f4-4d18-a6dd-b88ea0a99e53
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 200470 ms
Total Talk Time (AGENT): 99188 ms
Total Talk Time (CUSTOMER): 25986 ms
Interruptions: 0
Overall Sentiment: AGENT=2.4, CUSTOMER=2.7
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/01/29/f8a0d3ae-74f4-4d18-a6dd-b88ea0a99e53_20250129T14:23_UTC.wav
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[AGENT][POSITIVE] Good morning. Thank you for calling APL. This is [PII]. How can I help you?
[CUSTOMER][POSITIVE] Good morning. My name is [PII]. I'm calling to get outpatient benefits for a member.
[AGENT][NEUTRAL] OK [PII], you're needing outpatient benefits for a member, is that correct?
[CUSTOMER][NEUTRAL] Yes.
[AGENT][POSITIVE] Yes ma'am. I can help you with that. And do you also need eligibility or strictly just benefits?
[CUSTOMER][NEUTRAL] Um, both please.
[AGENT][NEUTRAL] Yes ma'am. OK, and what is your callback number?
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] Thank you and the member's policy number please [PII]?
[CUSTOMER][NEUTRAL] 02255760
[AGENT][POSITIVE] Thank you, one moment.
[AGENT][NEUTRAL] And any information that I provide for you today, [PII] would be a verification of benefits and not a guarantee of payment. What is your patient's name and date of date of birth?
[CUSTOMER][NEUTRAL] [PII] with the date of birth of [PII].
[AGENT][POSITIVE] OK. Thank you.
[AGENT][NEUTRAL] So I do show he is a subscriber on the supplemental policy and it is active with an effective date of [PII].
[AGENT][NEUTRAL] And on his outpatient benefit, the maximum is $1000 per covered person per calendar year for covered outpatient services.
[AGENT][NEUTRAL] And there is no outpatient deductible per cover person per calendar year.
[CUSTOMER][NEUTRAL] And do they have the full amount available?
[AGENT][NEUTRAL] One moment.
[AGENT][NEUTRAL] Yeah.
[AGENT][NEUTRAL] And for this calendar year as of now, no benefits have been used and because it is a supplemental policy, [PII], we will also have to have a copy of the primary insurance company's explanation of benefits along with the claim for review and then we do have our portal once our claim has been processed that you should be able to check claim status in by going to secured.
[CUSTOMER][POSITIVE] Perfect.
[CUSTOMER][NEUTRAL] Mm.
[AGENT][NEUTRAL] [PII].
[CUSTOMER][POSITIVE] Perfect thank you so much
[AGENT][POSITIVE] Well, you're welcome, [PII]. Is there anything else that I can help you with today?
[CUSTOMER][POSITIVE] No, that'll be all thank you.
[AGENT][POSITIVE] OK, well thank you for calling APL. I hope you have a great day.
[CUSTOMER][POSITIVE] Thanks you too bye bye.
[AGENT][POSITIVE] Thank you. Bye-bye.