AccountId: 011433970860
ContactId: 221bab20-cf07-47a5-ab7b-21fb7d52d1d1
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 201610 ms
Total Talk Time (AGENT): 104394 ms
Total Talk Time (CUSTOMER): 55333 ms
Interruptions: 0
Overall Sentiment: AGENT=1.5, CUSTOMER=1.3
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/04/01/221bab20-cf07-47a5-ab7b-21fb7d52d1d1_20250401T20:10_UTC.wav
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[AGENT][POSITIVE] Good afternoon. Thank you for calling APL. My name is [PII]. How may I help you?
[CUSTOMER][NEUTRAL] Yes, hi. I wanted to verify if we're in network with the patient's uh insurance as well as benefits.
[AGENT][POSITIVE] OK, I can help you with the network and the benefits. May I have your name and a good contact number in case we're disconnected?
[CUSTOMER][NEUTRAL] My name is [PII]. Contact number is [PII].
[AGENT][NEUTRAL] Thank you for that. And may I have the member's policy number?
[CUSTOMER][NEUTRAL] Yes, it is 02406108.
[AGENT][NEUTRAL] Thank you, hold on one moment.
[AGENT][NEUTRAL] And can you verify the member's first and last name and date of birth?
[CUSTOMER][NEUTRAL] [PII]. Date of birth is [PII].
[AGENT][NEUTRAL] Thank you for that and all the information provided is a verification of benefits, not a guarantee of payment. And so for the um Metlink policy, there's no network as with the secondary insurance. um, so we don't have a network that would be more for primary, and then what type of benefits did you want to go over?
[CUSTOMER][NEUTRAL] Surgical benefits?
[AGENT][NEUTRAL] Would it be outpatient or inpatient?
[CUSTOMER][NEUTRAL] Outpatient.
[AGENT][NEUTRAL] Hold on one second. So for outpatient, the policy would pay
[AGENT][NEUTRAL] Up to $500 per occurrence. Hold on one moment.
[AGENT][NEUTRAL] Wait a minute, let me double check. Sorry, for outpatient it's $250 per occurrence.
[CUSTOMER][NEUTRAL] OK. And how does it work? Do we submit a claim and then you will pay us or does the patient need to pay? How, how does it work with you guys?
[AGENT][NEUTRAL] Um, it would be, it could be both if you are required or if there's a co-pay or deductible that's required to receive services, they'll have to pay that first and then on the back end when we receive the claim, they could possibly be reimbursed so if there's something owed to you all as a provider, you can be paid as well, um, up to that $500 per occurrence.
[CUSTOMER][NEUTRAL] 250, right?
[AGENT][NEUTRAL] I'm sorry, yes, 250. They're right above each other and they're usually, usually not like that. I apologize.
[CUSTOMER][POSITIVE] No worries. Um, OK. And uh,
[CUSTOMER][NEUTRAL] So it doesn't matter if we're in network or not. I mean, he, you guys would pay up to $250.
[AGENT][NEUTRAL] Correct. Um, so for the secondary insurance, there is no network, so that would just really be for his primary insurance.
[CUSTOMER][NEUTRAL] Gotcha. OK. Can I have your name?
[AGENT][NEUTRAL] Sure, so my name is [PII], first initial to my last name is [PII].
[CUSTOMER][NEUTRAL] And the reference number, please?
[AGENT][NEUTRAL] So there's no call reference number, but you can use my name in today's date.
[CUSTOMER][POSITIVE] OK, perfect. Thank you so much for your help.
[AGENT][POSITIVE] You're very welcome and thanks for calling APL. Was there anything else I can assist you with today, [PII]?
[CUSTOMER][POSITIVE] Uh, no, that would be all. Thank you.
[AGENT][POSITIVE] Alright, have a good day.
[AGENT][NEUTRAL] Bye bye.
[CUSTOMER][NEUTRAL] You as well. Bye bye.