AccountId: 011433970860
ContactId: 1bc4d8b5-312c-4e9d-a083-287baedbe9a5
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 188500 ms
Total Talk Time (AGENT): 111783 ms
Total Talk Time (CUSTOMER): 68649 ms
Interruptions: 0
Overall Sentiment: AGENT=0.3, CUSTOMER=0.8
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/03/07/1bc4d8b5-312c-4e9d-a083-287baedbe9a5_20250307T13:19_UTC.wav
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[AGENT][NEUTRAL] Contacting APO. My name is [PII]. How may I help you?
[CUSTOMER][NEUTRAL] Hi [PII], I'm just calling to verify eligibility and benefits for a member. I don't have a card on file, so I hope I called the right number.
[AGENT][NEUTRAL] OK, I, and with whom am I speaking?
[CUSTOMER][NEUTRAL] [PII], last initial [PII]
[AGENT][NEUTRAL] OK, thank you, [PII]. I can certainly help with eligibility and benefits. Um, do you have any information on the patient, uh, maybe a name, a social security number?
[CUSTOMER][NEUTRAL] I have a member ID. Oh yeah, I have a patient information and I have a member ID.
[AGENT][NEUTRAL] OK, and what is the member ID please?
[CUSTOMER][NEUTRAL] It is 02589516.
[AGENT][NEUTRAL] OK, great. Thank you. And the patient's name and date of birth, please?
[CUSTOMER][NEUTRAL] OK
[CUSTOMER][NEUTRAL] [PII], [PII].
[AGENT][NEUTRAL] Thank you. And is there a callback number I can have in the event that we're disconnected?
[CUSTOMER][NEUTRAL] Yes, it is [PII].
[AGENT][NEUTRAL] Thank you. Uh, the policy went into effect on [PII]. It is active. Now, um, [PII], this is a secondary or gap insurance and what it's meant to do is pick up the deductible.
[AGENT][NEUTRAL] Co-payment or co-insurance from the major medical, um, so for inpatient stays of 18 hours or more, we will pick up the deductible, co-payment or co-insurance up to $2000 per calendar year for outpatient services, uh, such as the ER, urgent care, treatment within a physician's office, durable medical labs, that sort of thing.
[AGENT][NEUTRAL] We pick up the deductible co-payment or co-insurance from the major medical up to $2000 as well, and that's just a verification of benefits on a guarantee of payment, but that is what this policy benefits are. Is there anything in particular that I can help you with?
[CUSTOMER][NEUTRAL] I'm sorry, you started to cut out right after you um so that's what this policy is for. I didn't catch those last few words.
[AGENT][NEUTRAL] Oh,
[AGENT][NEUTRAL] OK. I, I was just wondering if there's anything else I can help you with. Did, did you get the benefits? Did you, um, that part came through, right? OK, yeah.
[CUSTOMER][NEUTRAL] I did. I
[CUSTOMER][NEUTRAL] Um, uh, yes, I did catch that, so there's no, no deductible or out of pocket maximum with this plan. I just, um.
[AGENT][NEUTRAL] Well, yes, yeah, we, we'll pay up that $2000. I mean, that's the, we won't, you know, we won't pay more than that, of course, and again, just a verification I guarantee payment, but yes, that's what we do is we're, we're meant to pick up uh the deductible co-payment or co-insurance from their major medical up to that amount.
[CUSTOMER][NEUTRAL] Covers what
[CUSTOMER][NEUTRAL] Right.
[CUSTOMER][NEUTRAL] Right.
[CUSTOMER][NEUTRAL] OK, and then do you require pre-certification for surgical procedures, outpatient hospital?
[AGENT][NEUTRAL] Um, no, not really, because, uh, because we're not, we're the secondary and as long as you're in network with the, with the major medical, yeah, those are the people that you need to make sure you're in, in network with, not us. I mean, because we follow there.
[CUSTOMER][NEUTRAL] Since it is
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Sure. Right.
[CUSTOMER][POSITIVE] OK, that's perfectly fine, thank you so much and can I get your last initial and a reference number for the call?
[AGENT][NEUTRAL] Yes, yes, it's K as in kite, and we're gonna use that in today's date is as our reference.
[CUSTOMER][POSITIVE] Alrighty thank you so much [PII] I appreciate it.
[AGENT][POSITIVE] Thanks for contacting APR have a good one.