AccountId: 011433970860
ContactId: 19855e1d-8fee-4ea2-82d4-1647f944b801
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 304750 ms
Total Talk Time (AGENT): 154238 ms
Total Talk Time (CUSTOMER): 99894 ms
Interruptions: 2
Overall Sentiment: AGENT=0.5, CUSTOMER=0.1
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/01/08/19855e1d-8fee-4ea2-82d4-1647f944b801_20250108T21:51_UTC.wav
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[AGENT][NEUTRAL] Thank you for calling APL. This is [PII]. How may I help you?
[CUSTOMER][NEUTRAL] Yeah, hi, my name is [PII], and my last name is [PII]. I'm calling you from provider office to check your deliver day. My name is. Please help me.
[AGENT][NEUTRAL] Uh, yes, and you're calling from the provider's office and I didn't get that second part, um, you needed help with claims, is that correct?
[CUSTOMER][NEUTRAL] I'm looking for eligibility and benefits.
[AGENT][NEUTRAL] Oh, eligibility. OK, I can help you with eligibility, [PII]. What is your callback number, please, just in case our call is disconnected.
[CUSTOMER][NEUTRAL] [PII] is your direct line?
[AGENT][NEUTRAL] OK, thank you. And then what is the patient's name?
[CUSTOMER][NEUTRAL] Patient's name will be?
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] OK. And then what's [PII]'s date of birth?
[CUSTOMER][NEUTRAL] And the date of birth will be?
[CUSTOMER][NEUTRAL] It's [PII].
[AGENT][NEUTRAL] OK, and now what is [PII]'s policy number?
[CUSTOMER][NEUTRAL] Policy number is gonna be 022865.
[CUSTOMER][NEUTRAL] 43 M as in Mike L as in Lima 8.
[AGENT][NEUTRAL] OK, thank you and what is the uh.
[AGENT][NEUTRAL] OK, I got it. I got the policy number 02286543. Is that correct? ML8.
[CUSTOMER][NEUTRAL] Yes.
[AGENT][POSITIVE] OK, thank you.
[CUSTOMER][NEUTRAL] Yes.
[AGENT][NEUTRAL] OK, I do show that [PII] does have an active policy. Her effective date is.
[CUSTOMER][NEUTRAL] Yeah.
[AGENT][NEUTRAL] [PII].
[AGENT][NEUTRAL] No, I'm sorry, that's [PII].
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] And can I also have the, uh, sorry, uh, term date.
[AGENT][NEUTRAL] There is no termination date the policy is still active.
[CUSTOMER][NEUTRAL] OK, so can I have the plan type?
[AGENT][NEUTRAL] Medlink
[CUSTOMER][NEUTRAL] OK, so can I have the benefits now?
[AGENT][NEUTRAL] Uh, yes, and this is just to verify coverage. It's not a guarantee of payment. This is a supplemental insurance policy that's billed secondary to the primary. It's a gap insurance, but it helps with deductible, co-pay and co-insurance. The insured has an inpatient benefit amount per calendar year of $3400 and then the the insured also has a benefit for outpatient per covered day of $500.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] OK, so the benefits falls under copay or deductible.
[AGENT][POSITIVE] And specifically helps with.
[AGENT][NEUTRAL] No, this specifically helps with deductible, co-pay or co-insurance.
[CUSTOMER][NEUTRAL] Yeah
[CUSTOMER][NEUTRAL] Copay or coinsurance?
[AGENT][NEUTRAL] Right, and deductible.
[CUSTOMER][NEGATIVE] I couldn't get it, ma'am. It should be neither uh copay or.
[CUSTOMER][NEUTRAL] Or, uh, deductible, it can't be both. Can you please verify it for me?
[AGENT][POSITIVE] Yes, it can.
[AGENT][NEUTRAL] Yes, so when the primary insurance files a claim and the insured has to pay a deductible or if the insured has to pay a copay or if the insured has to pay a co-insurance.
[AGENT][NEUTRAL] Then the claim is sent to us.
[AGENT][NEUTRAL] This policy will help pick up what the insured had to pay for deductible or co-pay or co-insurance.
[CUSTOMER][NEUTRAL] OK, so the primary want to pay $55 copay.
[CUSTOMER][NEUTRAL] So
[CUSTOMER][NEUTRAL] Can I know how much will this cover?
[AGENT][NEUTRAL] The is it for inpatient or outpatient?
[CUSTOMER][NEUTRAL] It's for outpatients
[AGENT][NEUTRAL] OK, so outpatient, she has a benefit of $500 per calendar day.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] Once that $500 is reached for that day.
[CUSTOMER][NEUTRAL] OK honey.
[CUSTOMER][NEUTRAL] I
[AGENT][NEGATIVE] If they use their whole 5 to $100 in one day, then the benefit is exhausted for that day.
[CUSTOMER][POSITIVE] OK, thank you, thank you for assistance and have a nice day. And before that, uh, before cutting the call, can I know your name once again and call reference number for this call?
[AGENT][NEUTRAL] Yes, my name is [PII]
[AGENT][NEUTRAL] And you can use my name and today's date for the reference number.
[CUSTOMER][NEUTRAL] Can I have the last initial please?
[AGENT][NEUTRAL] It is [PII]
[CUSTOMER][POSITIVE] Do got it. Thank you all for us and have a nice day.
[AGENT][POSITIVE] You're welcome [PII]. You have a great day and thanks for calling APL, sir.
[CUSTOMER][NEUTRAL] You too. Bye-bye.
[AGENT][NEUTRAL] Bye-bye.