AccountId: 011433970860
ContactId: 24de9c43-52d9-4c55-98d1-e2ccfb719912
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 159029 ms
Total Talk Time (AGENT): 79188 ms
Total Talk Time (CUSTOMER): 82796 ms
Interruptions: 2
Overall Sentiment: AGENT=1.4, CUSTOMER=0.3
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/04/11/24de9c43-52d9-4c55-98d1-e2ccfb719912_20250411T13:38_UTC.wav
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[AGENT][NEUTRAL] Thank you for calling APL. This is [PII]. How can I help you?
[CUSTOMER][NEUTRAL] Hi, good morning. My name is [PII]. I'm calling from Sin Orthopedic Center regarding a mutual patient or client. Um, they have you guys as a secondary, and I was wondering if you guys picked up like their like any financial responsibility.
[AGENT][POSITIVE] I'm sure [PII] I can assist you with benefits. Um, first, could I get a good callback number just in case we're disconnected?
[CUSTOMER][NEUTRAL] Uh
[CUSTOMER][NEUTRAL] Yes, it's [PII].
[AGENT][NEUTRAL] Thank you. Now, I need the policy number, please.
[CUSTOMER][NEUTRAL] Yes, the policy number is 02610272 M like Mary L like Larry the number 8.
[AGENT][NEUTRAL] Thank you. Now, please verify the patient's name and date of birth.
[CUSTOMER][NEUTRAL] Yes, um, [PII] sorry, and date of birth is [PII].
[AGENT][NEUTRAL] Thank you and just let me advise you that verification of coverage does not guarantee payment of claims. Um, the effective date on this policy was [PII]. The policy is still active. And is this for inpatient or outpatient benefits or an office visits?
[CUSTOMER][NEUTRAL] And
[CUSTOMER][NEUTRAL] That
[CUSTOMER][NEUTRAL] That
[CUSTOMER][NEUTRAL] Office visit for a specialist.
[AGENT][NEUTRAL] Mm
[AGENT][NEUTRAL] OK, for services provided in office, we cover up to $1000 per day and that's for the co-insurance and the deductible after the primary insurance processes the claim, but the co-pay for the office visit is not covered.
[CUSTOMER][NEUTRAL] And
[CUSTOMER][NEUTRAL] I
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] And is this also like X-rays, injections, things like that as well like.
[AGENT][POSITIVE] Yes, ma'am. That takes place in office. Yes, that's correct.
[CUSTOMER][NEUTRAL] OK perfect and then what about um an MRI?
[AGENT][NEUTRAL] Yes, ma'am. MRI's are covered as well, as long as it's related to an illness or an injury, and it's also covered by the primary insurance.
[CUSTOMER][NEUTRAL] I'll do that with the.
[CUSTOMER][NEUTRAL] OK perfect all right that sounds good and then can I have a reference number for this call as well?
[AGENT][NEUTRAL] Um, yes, for the reference number, you can use my name and today's date. My name is [PII] [PII] and today's date. Um, is there anything else I can assist you with?
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][POSITIVE] No, that's gonna be all thank you so much for your help.
[AGENT][POSITIVE] OK, thank you, Ada, for calling APL. Have a great weekend, bye.
[CUSTOMER][NEUTRAL] You too bye.