AccountId: 011433970860
ContactId: 0275d00b-ca2a-42ad-a38c-37f95c1df243
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 254440 ms
Total Talk Time (AGENT): 88269 ms
Total Talk Time (CUSTOMER): 97162 ms
Interruptions: 0
Overall Sentiment: AGENT=1.1, CUSTOMER=0
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/02/20/0275d00b-ca2a-42ad-a38c-37f95c1df243_20250220T14:36_UTC.wav
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[AGENT][POSITIVE] Good morning. Thank you for calling APL. My name is [PII]. How may I help you?
[CUSTOMER][NEUTRAL] Hi [PII]. Uh, my name is [PII]. My last initial is [PII]. I'm calling from a facility to see if a patient has active coverage and eligibility, please.
[AGENT][POSITIVE] [PII], it would be my pleasure to assist you with eligibility. What is the callback number?
[CUSTOMER][NEUTRAL] It is [PII].
[AGENT][NEUTRAL] Thank you, [PII]. And what is the policy number for the patient, please?
[CUSTOMER][NEUTRAL] It is 0887317 MLB.
[AGENT][NEUTRAL] And you said 088?
[CUSTOMER][NEUTRAL] 018871, sorry, start again, 018801887317 ML 8.
[AGENT][NEUTRAL] Thank you. [PII], what is the patient's name and date of birth?
[CUSTOMER][NEUTRAL] This is for um [PII], that's [PII], and her date of birth is [PII].
[AGENT][NEUTRAL] Mhm.
[AGENT][POSITIVE] All right, thank you. [PII], it would be my pleasure to assist you with that eligibility for [PII]. Her policy is active. Effective date is [PII].
[AGENT][NEUTRAL] And this is a secondary policy to the policyholders' major medical.
[CUSTOMER][NEUTRAL] OK, it's secondary and um.
[AGENT][NEUTRAL] Yes.
[CUSTOMER][NEUTRAL] Uh, does it cover any co-pays that the uh the the secondary, the primary does not cover.
[AGENT][NEUTRAL] Is it for an uh what type of facility? Office, outpatient?
[CUSTOMER][NEUTRAL] Uh, free, uh, well, we, we bill his office.
[AGENT][NEUTRAL] OK, now she does have benefits for any procedures or treatments in the office but not for the office visit copay.
[CUSTOMER][NEUTRAL] OK. She's doing a, um, we're a MRI uh uh we're a freestanding radiology facility. She's having a CAT scan, 74,150.
[AGENT][NEUTRAL] OK. So she does have what's called the office treatment rider that does cover procedures for treatments or diagnostic testing.
[AGENT][NEUTRAL] And that benefit amount is $6600 per calendar year.
[AGENT][NEUTRAL] That we can pay for her deductible copay or co-insurance of the major medical.
[CUSTOMER][NEUTRAL] 6600.
[AGENT][NEUTRAL] Yes, sir.
[CUSTOMER][NEUTRAL] has she met any of that?
[AGENT][NEUTRAL] For [PII], she has not used any of that benefit as of right now.
[CUSTOMER][NEUTRAL] OK, alright, cool, uh, then I'll put it down that the co-pay will be, uh, or whatever the amount will be covered by the secondary, um, does your portal need require a log in?
[AGENT][NEUTRAL] No
[AGENT][NEUTRAL] All you would need now we would have to have a prior claim on file and to create a password you would just use your tax ID number.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Are you still there?
[CUSTOMER][NEUTRAL] [PII], I lost you.
[CUSTOMER][NEUTRAL] Hello [PII].
[CUSTOMER][NEUTRAL] Are you still there?
[CUSTOMER][NEUTRAL] I'm sorry [PII], I can't hear you.
[CUSTOMER][NEUTRAL] Hello.