AccountId: 011433970860
ContactId: fec9a0ea-f130-4a3a-bd1e-d083c5ef6895
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 324989 ms
Total Talk Time (AGENT): 153921 ms
Total Talk Time (CUSTOMER): 57651 ms
Interruptions: 0
Overall Sentiment: AGENT=1.4, CUSTOMER=1.1
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/05/05/fec9a0ea-f130-4a3a-bd1e-d083c5ef6895_20250505T14:15_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] Hi, [PII]. I'm calling to verify benefits for one of your members.
[AGENT][NEUTRAL] OK, are you also needing eligibility or strictly just benefit information?
[CUSTOMER][NEUTRAL] Just benefit information.
[AGENT][POSITIVE] Yes, ma'am. I can help you with that. And who am I speaking with, please?
[CUSTOMER][NEUTRAL] [PII].
[AGENT][POSITIVE] Thank you. And [PII], what is a good callback number for you, please?
[CUSTOMER][NEUTRAL] [PII]
[AGENT][NEUTRAL] Thank you and the member's policy number please, [PII].
[CUSTOMER][NEUTRAL] 01753781 M as in Mary L as in Lima 7
[AGENT][NEUTRAL] OK, thank you one moment while I get the member's information pulled up please.
[AGENT][NEUTRAL] OK, and any information, [PII] that I provide for you would be a verification of benefits and not a guarantee of payment. What is your patient's name and date of birth?
[CUSTOMER][NEUTRAL] Uh, hold on.
[CUSTOMER][NEUTRAL] [PII].
[CUSTOMER][NEUTRAL] [PII]
[AGENT][NEUTRAL] OK, thank you. Now the policy number you gave me is an old policy number that's no longer active. This policy actually turns [PII], but they do have another policy that is currently active, so give me just a moment to get that policy information pulled up.
[AGENT][NEUTRAL] OK, so the currently active policy number that you should have is 022.
[AGENT][NEUTRAL] 03.
[AGENT][NEUTRAL] 915.
[AGENT][NEUTRAL] This policy has an effective date of [PII]. 0, you said you didn't really need that, but since you had an old policy number, I wanted to go ahead and give you that.
[AGENT][NEUTRAL] OK just one moment.
[CUSTOMER][NEUTRAL] And that was 022 03915?
[AGENT][POSITIVE] That is correct. Yes, ma'am.
[CUSTOMER][POSITIVE] Thank you.
[AGENT][POSITIVE] You're welcome.
[AGENT][NEUTRAL] OK, and again this is a supplemental policy to their primary insurance. So what type of benefit information do you need inpatient, outpatient or office?
[CUSTOMER][NEUTRAL] Uh, this is outpatient. No, I'm sorry, inpatient hospital.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] Inpatient? OK.
[AGENT][NEUTRAL] OK, so the inpatient benefit max per calendar year is 8 excuse me, per cover person is $8500 and there is no deductible.
[AGENT][NEUTRAL] Because this is a supplemental policy to their primary insurance though, [PII], we will have to have a copy of the primary insurance company's explanation of benefits along with the claim for review.
[AGENT][NEUTRAL] And then once we have processed our claim here at APL we do have a portal in which you should be able to check our claim status in by going to secured.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] [PII]
[AGENT][NEUTRAL] [PII].
[CUSTOMER][NEUTRAL] OK, and of the $8500 max per year, has anything been used this year?
[AGENT][NEUTRAL] As in for an inpatient admission?
[CUSTOMER][NEUTRAL] Yes.
[AGENT][NEUTRAL] I can check that.
[AGENT][NEUTRAL] Uh, no, ma'am.
[AGENT][NEUTRAL] As of now, there has not been.
[CUSTOMER][NEUTRAL] OK. And [PII], what is our call reference?
[AGENT][NEUTRAL] My name along with today's date.
[AGENT][NEUTRAL] And if you need the first.
[CUSTOMER][NEUTRAL] And are you a [PII] or [PII]?
[AGENT][NEUTRAL] Neither, just an [PII]
[CUSTOMER][POSITIVE] Just an [PII] OK. Thank you so much for your help. I appreciate it.
[AGENT][NEUTRAL] Mhm. Yes.
[AGENT][POSITIVE] Oh, you're very welcome. And is there anything else that I can help you with?
[CUSTOMER][POSITIVE] Thank you.
[CUSTOMER][NEUTRAL] Uh, no, thank you.
[AGENT][POSITIVE] OK, well then, thank you for calling APL [PII]. I hope you have a great day.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][POSITIVE] Thank you. Bye-bye.
[AGENT][NEUTRAL] Bye bye.