AccountId: 011433970860
ContactId: 0e1bb63b-b65f-489e-b8dc-b50210d78d85
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 160270 ms
Total Talk Time (AGENT): 70416 ms
Total Talk Time (CUSTOMER): 55795 ms
Interruptions: 0
Overall Sentiment: AGENT=1.5, CUSTOMER=1
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/01/14/0e1bb63b-b65f-489e-b8dc-b50210d78d85_20250114T19:33_UTC.wav
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[AGENT][NEUTRAL] Thank you for calling APL. This is [PII]. How can I help you?
[CUSTOMER][NEUTRAL] Hi, this is [PII] with Doctor [PII]'s office. I need to get some benefits for patients secondary health plan.
[AGENT][POSITIVE] Alright, [PII], I'm happy to check that for you. What's your policy number?
[CUSTOMER][NEUTRAL] 21803009
[AGENT][POSITIVE] Alright, thank you so much. Let me just pull this up here one moment.
[AGENT][NEUTRAL] Patient name and date of birth?
[CUSTOMER][NEUTRAL] [PII] [PII].
[AGENT][POSITIVE] Thank you so much. So patient plan is active. The effective date is for [PII].
[AGENT][NEUTRAL] It looks like the outpatient benefit max on this plan is a total of 6000 for the calendar year and inpatient is 8000.
[CUSTOMER][NEUTRAL] So when you say that that means they don't have a deductible, they don't have a co-insurance, they don't have an out of pocket, they just pay a maximum payment amount.
[AGENT][NEUTRAL] That's the max that the plan will pay out correct. This is their secondary insurance, so this is gonna cover deductible, co-pay, co-insurance, or primary doesn't.
[CUSTOMER][NEUTRAL] OK, so max payment. And what's the max payment for for outpatient surgery for the doctor?
[AGENT][NEUTRAL] Outpatient max for the year is 6000.
[CUSTOMER][NEUTRAL] OK, so do we collect from the patient up front um what they're responsible for and then they get reimbursed?
[AGENT][NEUTRAL] So yeah you can do it either way it's up to y'all I mean you can build the primary and then bill a secondary um for anything remaining over or um.
[AGENT][NEUTRAL] Yeah, I mean, the patient can file the claim on their own as well and be reimbursed.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] So the maximum payout payment is $6000 per year um and that covers, I'm just writing everything down and that covers um the primary.
[AGENT][NEUTRAL] Uh, deductible, co-pay and yeah, co-pay and co-insurance.
[CUSTOMER][NEUTRAL] Deductible
[CUSTOMER][NEUTRAL] OK
[CUSTOMER][NEUTRAL] OK, so max payment is $6000 per year covers primary deductible copay and insurance.
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][POSITIVE] Got it. OK, thank you so much and can I have your name and initial or reference number call number?
[AGENT][NEUTRAL] Absolutely, [PII]. Call references my name with my last initial then today's date. My name again is [PII], that's [PII] Last initials, my name is [PII].
[CUSTOMER][POSITIVE] And today's date [PII]. OK, thank you for your help.
[AGENT][NEUTRAL] Mhm.
[AGENT][POSITIVE] You're welcome. Have a good one.
[CUSTOMER][NEUTRAL] You too bye bye.
[AGENT][NEUTRAL] Bye bye.