AccountId: 011433970860
ContactId: 11333e4b-e02a-4e1d-8108-efa09c9d9d6b
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 281670 ms
Total Talk Time (AGENT): 81502 ms
Total Talk Time (CUSTOMER): 108142 ms
Interruptions: 0
Overall Sentiment: AGENT=0.8, CUSTOMER=0.2
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/06/05/11333e4b-e02a-4e1d-8108-efa09c9d9d6b_20250605T20:24_UTC.wav
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[AGENT][POSITIVE] Thanks for calling APL. This is [PII]. How can I help you?
[CUSTOMER][NEUTRAL] Hi, [PII]. My name is [PII]. My last name initial is [PII]. And I'd like to check if there's any active policy for this number and to check the eligibility and benefit details if it does, you'll be able to look that up?
[AGENT][NEUTRAL] Uh, yes, I can help you with eligibility and benefits, [PII], do you have a good callback number?
[CUSTOMER][NEUTRAL] Yes, that is [PII].
[AGENT][NEUTRAL] And policy number for the patient?
[CUSTOMER][NEUTRAL] The policy number I have is 1418226 M as in Mike L as in Lima 8.
[AGENT][NEUTRAL] And patient name and date of birth?
[CUSTOMER][NEUTRAL] Patient name is [PII] and last name spelled as [PII], I'm sorry, [PII]
[AGENT][NEUTRAL] And the date of birth?
[CUSTOMER][NEUTRAL] That is on [PII].
[AGENT][NEUTRAL] OK, it looks like this policy is active and effective [PII].
[AGENT][NEUTRAL] And are you needing benefits for outpatient services or?
[CUSTOMER][NEUTRAL] Yeah, for outpatient ambulatory surgical center, built on the facility.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] This is not a guarantee of payment. It's a basic outline of the policy.
[AGENT][NEUTRAL] Um, let's see. Give me one moment.
[AGENT][NEUTRAL] OK, so it looks like under her policy, uh, this plan will pay up to $2500 per calendar year.
[CUSTOMER][NEUTRAL] And then is it like a deductible or an out of pocket maximum?
[AGENT][NEUTRAL] No, this is gonna pay after primary processes the claim. So if there's any deductible, co-pay or co-insurance left over from the primary insurance, we will pay 100% up to 2500.
[CUSTOMER][NEUTRAL] OK, um.
[CUSTOMER][NEUTRAL] Check.
[AGENT][NEUTRAL] It's a secondary plan.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK. So if it's, if uh the primary primary insurance responsibility is
[CUSTOMER][NEUTRAL] The remaining responsibility is more than $2500 it will not be covered, right? We will only cover up to $2500. That's right?
[AGENT][NEUTRAL] Yes, we'll pay to a maximum of 2500 per calendar year.
[CUSTOMER][NEUTRAL] So there's no deductible, co-insurance or out of pocket applies for the service, right?
[AGENT][POSITIVE] That's correct.
[CUSTOMER][NEUTRAL] OK. Will you be able to confirm if an authorization required for the procedure code if I give you the codes?
[AGENT][NEUTRAL] Uh, there's no prior author required since we're secondary for anything.
[CUSTOMER][NEUTRAL] Got it, got it. Thank you for clarifying on that. And I hope there's no group number for this plan, for this number?
[AGENT][NEUTRAL] Um number is.
[AGENT][NEUTRAL] Uh, it's 18,490.
[CUSTOMER][NEUTRAL] 0, OK.
[CUSTOMER][NEUTRAL] And this is the primary, I'm sorry, this is the secondary plan, right? And the patient is the subscriber for this policy, I hope.
[AGENT][NEUTRAL] Yes.
[AGENT][POSITIVE] Yes, that's correct.
[CUSTOMER][NEUTRAL] OK. And may I know the plant type as well?
[AGENT][NEUTRAL] Uh, it's a secondary.
[CUSTOMER][NEUTRAL] Um, is there like a plant type like BPO HMO?
[AGENT][NEUTRAL] It's, it's neither of those, doesn't have a network, so it's just, it's a secondary policy.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK, got it.
[CUSTOMER][NEUTRAL] Thank you for verifying that details. And can I get your name and call reference for this, please?
[AGENT][NEUTRAL] A call reference is my name, [PII], first initial to last name, [PII], and today's date.
[CUSTOMER][POSITIVE] OK. Got it, [PII]. Thank you very much for that info and hope you have a wonderful day ahead. Bye.
[AGENT][POSITIVE] OK, thanks for calling APL. You too. Bye-bye.