AccountId: 011433970860
ContactId: 194e9d0f-f368-497f-9223-9c561f92ebbd
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 229419 ms
Total Talk Time (AGENT): 101915 ms
Total Talk Time (CUSTOMER): 79031 ms
Interruptions: 0
Overall Sentiment: AGENT=-0.2, CUSTOMER=0.7
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/01/13/194e9d0f-f368-497f-9223-9c561f92ebbd_20250113T16:46_UTC.wav
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[AGENT][NEUTRAL] Thank you for calling APL. This is [PII]. How may I help you?
[CUSTOMER][NEUTRAL] Hi, good morning. My name is [PII]. I'm calling from Brownsville Surgery Center. I'm trying to verify eligibility on a patient.
[AGENT][NEUTRAL] OK, spell your name for me.
[CUSTOMER][NEUTRAL] [PII]
[AGENT][NEUTRAL] I'm sorry.
[CUSTOMER][NEUTRAL] [PII]
[AGENT][NEUTRAL] [PII], OK. And what's the policy number, [PII]?
[CUSTOMER][NEUTRAL] The uh the patient's ID number is Z. I'm sorry, one second.
[CUSTOMER][NEUTRAL] The ID number is 02552722.
[AGENT][NEUTRAL] OK, you're cutting in and out. I have 0255.
[CUSTOMER][NEUTRAL] 2722.
[AGENT][NEUTRAL] OK, and what's a good phone number in case we're disconnected?
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEGATIVE] OK, you're cutting out really bad. Can you repeat the number?
[CUSTOMER][NEUTRAL] [PII]
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] 2248.
[AGENT][NEUTRAL] OK, and [PII], did you say you needed benefit information?
[CUSTOMER][NEUTRAL] Yes, ma'am. The patient is coming in for an outpatient um procedure.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] Give me a second to pull up her uh policy information, OK?
[CUSTOMER][NEUTRAL] Yes, ma'am.
[AGENT][NEUTRAL] And the patient's name and date of birth?
[CUSTOMER][NEUTRAL] Uh [PII] Soto. Date of birth is [PII].
[AGENT][NEUTRAL] OK, thank you for that information. The policy effective date is [PII].
[AGENT][NEUTRAL] Uh, the policy is active at this time.
[AGENT][NEUTRAL] And the maximum outpatient benefit is up to $2550.
[AGENT][NEUTRAL] Per calendar year.
[AGENT][NEUTRAL] The information provided is verification, not a guarantee of payment, and I don't show any claims on file for her this year.
[CUSTOMER][NEUTRAL] OK. Um, has the patient accumulated anything out of pocket? You said it's 2550?
[AGENT][NEUTRAL] I don't show any claims paid this year, so the 2550 is available.
[CUSTOMER][NEUTRAL] OK, so nothing has been met. Does the patient has a deductible or a co-pay, co-insurance?
[AGENT][NEUTRAL] At this time?
[AGENT][NEUTRAL] OK, so on the card, I think it should say this is a Metlink policy, so it's secondary to her primary insurance. Um, any amount, the primary
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] I, I, I'm only calling cause I don't have access to the patient's card, so I don't know what the cards say.
[AGENT][NEUTRAL] So this is secondary to the primary insurance plan. Uh, any amount that primary applies towards either their deductible, co-insurance, or co-pay amount of covered charges, this policy will reimburse those amounts up to 2550 per calendar year.
[AGENT][NEUTRAL] So this is gonna be secondary to the major medical plan.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Got you. And so, basically, it goes off, you saying it goes off the primary insurance?
[AGENT][NEUTRAL] Whatever the primary applies towards deductible, co-insurance and or co-pay amounts.
[CUSTOMER][NEUTRAL] OK, and they are responsible for. OK, um.
[AGENT][NEUTRAL] Yes.
[CUSTOMER][POSITIVE] OK, thank you so much. May I get a reference number for this call, please?
[AGENT][NEUTRAL] You'll use my name in today's date, [PII] last [PII] is [PII]. Any other questions I can help out with today?
[CUSTOMER][POSITIVE] No, ma'am. Thank you. I hope you have a blessed day. Bye-bye.
[AGENT][NEUTRAL] You