AccountId: 011433970860
ContactId: 1980553a-4d69-4de6-8af8-6ae3fff75a3c
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 182649 ms
Total Talk Time (AGENT): 75850 ms
Total Talk Time (CUSTOMER): 61593 ms
Interruptions: 1
Overall Sentiment: AGENT=0.7, CUSTOMER=0.6
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/04/02/1980553a-4d69-4de6-8af8-6ae3fff75a3c_20250402T14:44_UTC.wav
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[AGENT][NEUTRAL] Calling APL, my name is [PII]. How can I assist you today?
[CUSTOMER][NEUTRAL] Yes ma'am, I work at Neuromedical Center and I'm trying to verify eligibility for a patient here.
[AGENT][POSITIVE] I'd be happy to assist with eligibility. May I have your first name please?
[CUSTOMER][NEUTRAL] [PII].
[AGENT][POSITIVE] And even if I can get a good call back number for you?
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] And what is the policy number?
[CUSTOMER][NEUTRAL] Policy number is 02595732.
[AGENT][NEUTRAL] Patient's name and date of birth.
[CUSTOMER][NEUTRAL] [PII], date of birth [PII].
[AGENT][NEUTRAL] Thank you for that information. Please be advised the verification of coverage is not a guarantee of payment. I do show the policy is currently active. Effective date is [PII].
[AGENT][NEUTRAL] And are you calling for inpatient or outpatient benefits?
[CUSTOMER][NEUTRAL] Outpatient.
[AGENT][NEUTRAL] I do show the outpatient calendar year maximum is $6900. Patient does have an outpatient deductible of $1000.
[AGENT][NEUTRAL] Let me see if he's met any.
[AGENT][NEUTRAL] OK, looks like um he has not used any of his benefits so far this year, so he will need to meet that $1000 deductible.
[CUSTOMER][NEUTRAL] And does he pay copay or does he pay towards the deductible?
[AGENT][NEUTRAL] I don't quite understand the question.
[CUSTOMER][NEUTRAL] Like, is there a copay to pay or he has to pay towards? yes.
[AGENT][NEUTRAL] Is this for an outpatient or is this the office visit?
[CUSTOMER][NEUTRAL] Office specialist.
[AGENT][NEUTRAL] OK, so
[AGENT][NEUTRAL] Now, the, for the office visit, only treatment and procedures.
[AGENT][NEUTRAL] Are covered the copay associated with the physician's charges is not covered, so he would be responsible for that.
[CUSTOMER][NEUTRAL] OK, but does he have like a set copay or?
[AGENT][NEUTRAL] Now, that's a question for his major medical, where his gap insurance?
[CUSTOMER][NEUTRAL] Or he would have to pay.
[CUSTOMER][NEUTRAL] Oh, OK.
[CUSTOMER][NEUTRAL] So I'm wondering if this would pick up because he has a primary would this pick up the copay of the other insurance or no?
[AGENT][NEUTRAL] Not the copay associated with the physician's charges, any um treatment or procedures.
[AGENT][NEGATIVE] would be covered, but not the co-pay.
[CUSTOMER][NEUTRAL] OK, OK.
[CUSTOMER][POSITIVE] All right, thank you so much.
[AGENT][NEUTRAL] Was there anything else I could assist with today?
[CUSTOMER][NEUTRAL] I believe that is it and you said active date is [PII]. Is there any um end date or not as of now?
[AGENT][NEUTRAL] No, we don't have an end date.
[CUSTOMER][POSITIVE] OK, thank you so much.
[AGENT][POSITIVE] Thank you for calling APO you have a good day.