AccountId: 011433970860
ContactId: 0f491927-eeed-434d-923b-e8d7a36e86f9
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 292380 ms
Total Talk Time (AGENT): 160930 ms
Total Talk Time (CUSTOMER): 123843 ms
Interruptions: 4
Overall Sentiment: AGENT=1.8, CUSTOMER=0.3
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/03/26/0f491927-eeed-434d-923b-e8d7a36e86f9_20250326T14:53_UTC.wav
--------------------------------------------
[AGENT][POSITIVE] Good morning. Thank you for calling APL. This is [PII]. How may I help you today?
[CUSTOMER][NEUTRAL] Hi, yes, my name is [PII]. I'm calling from Asho Health. I'm trying to verify the benefit for one of my patients.
[AGENT][POSITIVE] Alright, [PII], I'll be glad to help you. Go ahead and give me a good policy number, please, ma'am.
[CUSTOMER][NEUTRAL] Patient's policy is 02566408. Patient's name is [PII]. Date of birth is [PII].
[AGENT][POSITIVE] Alrighty, thank you for all that information, [PII], and while I'm putting this information up, go ahead and give me a good return telephone call number.
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] Alright, [PII], thank you for all that information. Now you did say that you want uh some type of benefits. Is that correct?
[CUSTOMER][POSITIVE] Correct.
[AGENT][NEUTRAL] OK, what exact benefit are you needing today on [PII]?
[CUSTOMER][NEUTRAL] Patient is having an outpatient procedure.
[CUSTOMER][NEUTRAL] And I need to know if she have any coverage available.
[AGENT][NEUTRAL] Alrighty, let me get over to that benefit pack. Now what we are, of course, is her medical supplemental plan, and I do show this uh plan went into effect [PII]. She is current and active, but I must advise that verification of coverage is not a guarantee of payment on the claim.
[AGENT][NEUTRAL] And what we of course would pick up and pay for is it has to be applied towards her deductible, co-pay, or co-insurance at her primary insurance carrier, and that would be for sickness and accident only. Nothing routine here is covered no matter what. Now that outpatient benefit here is going to be uh no pre-cert, no deductible, and she has a benefit of $250 payable per occurrence.
[AGENT][NEUTRAL] What that means is every 90 days, she has $250 for that condition.
[CUSTOMER][NEUTRAL] Um, OK, so how much, oh, I'm sorry, how much is the coverage?
[AGENT][NEUTRAL] It's $250 per occurrence. $250 that's what we pay.
[CUSTOMER][NEUTRAL] Oh, so 250 per day in another word.
[AGENT][NEUTRAL] Mm
[AGENT][NEUTRAL] Uh, no, ma'am, that is per occurrence. That means any diagnosis that's related to that has a max of $250 payable.
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] OK, so I'm a little bit confused. I never heard this before, to be honest, um, so.
[AGENT][NEGATIVE] I know, it, it, it is a little confusing.
[CUSTOMER][NEUTRAL] It is, yeah, it's a little bit confused. So, OK, so the patient is having a colonoscopy and endoscopy for the doctor is $335. That's the responsibility by her primary insurance. So that means that that $250 will be the only thing that they pay, and that's included for the doctor in the facility or how it works for everything, 250.
[AGENT][NEUTRAL] Mhm.
[AGENT][NEUTRAL] That
[AGENT][NEUTRAL] Everything
[AGENT][POSITIVE] Everything, $250 is max. Whatever bill comes in here first, we'll get that $250 benefit as long as it's applied towards the deductible, co-pay or co-insurance at her primary insurance carrier.
[CUSTOMER][NEUTRAL] I
[CUSTOMER][NEUTRAL] So they only paid up to 501.
[AGENT][POSITIVE] That is correct.
[AGENT][NEUTRAL] Per condition, right.
[CUSTOMER][NEUTRAL] Oh, OK, so can I have
[CUSTOMER][NEUTRAL] OK, alright, so let me have your name and a reference number please.
[AGENT][NEUTRAL] We do not give reference numbers, [PII], but you can use my name in today's date and my name is [PII] spelled [PII] And is that all that I can help answer for you today, [PII]?
[CUSTOMER][NEUTRAL] What
[CUSTOMER][NEUTRAL] OK, so I'm sorry, I have somebody talking next to me. [PII], that's what you say?
[AGENT][NEUTRAL] [PII]
[CUSTOMER][NEUTRAL] I'm sorry, what was that?
[AGENT][NEUTRAL] [PII]
[CUSTOMER][NEUTRAL] The same
[CUSTOMER][NEUTRAL] I want, right?
[AGENT][NEUTRAL] No Awa, Awa.
[CUSTOMER][NEUTRAL] But
[CUSTOMER][NEUTRAL] I, I'm not getting it. I'm sorry. So you say that, that your name is [PII]?
[AGENT][NEUTRAL] No, ma'am. Uh, let's go over it again. It's [PII] yes.
[CUSTOMER][NEUTRAL] [PII].
[CUSTOMER][NEUTRAL] For.
[CUSTOMER][NEUTRAL] Got it and today's day, right?
[AGENT][NEUTRAL] All right. And today's date, yes, ma'am, May, is that all I can help you with?
[CUSTOMER][NEUTRAL] Mhm
[CUSTOMER][POSITIVE] OK, thank you so much. I really appreciate your help.
[AGENT][POSITIVE] Well, yes, ma'am, and thanks so much, [PII], for calling APL. You have a great day.
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] You too bye bye.
[AGENT][POSITIVE] Thank you. Bye-bye.