AccountId: 011433970860
ContactId: 2989c323-5db4-4d8e-907e-b01d24965c07
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 304399 ms
Total Talk Time (AGENT): 132625 ms
Total Talk Time (CUSTOMER): 82168 ms
Interruptions: 0
Overall Sentiment: AGENT=2.7, CUSTOMER=0.8
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/01/31/2989c323-5db4-4d8e-907e-b01d24965c07_20250131T16:31_UTC.wav
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[AGENT][POSITIVE] Thank you so much for calling APL. This is [PII]. How can I help you today?
[CUSTOMER][NEUTRAL] Hi [PII], um, I didn't quite hear an option to um get benefits for a patient that I have, so I was just seeing if you were able to help me with that or transfer me where I needed to go.
[AGENT][POSITIVE] Oh, I can, I can definitely help you with that today. Do you mind if I, um, do you mind if I get your name?
[CUSTOMER][NEUTRAL] Yeah, my name is [PII].
[AGENT][POSITIVE] Perfect, thank you so much, Ms. [PII] and we're looking for just benefits or are we needing some eligibility today too?
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Um, some eligibility. It looks like it's a secondary for a patient's Blue Cross. I just kind of see where we're at with that.
[AGENT][POSITIVE] Wonderful. OK, I'd love to help you, Miss. [PII], and real quick, do you mind if I snag a good callback number from you and then that policy number?
[CUSTOMER][NEUTRAL] Yeah, it's gonna be my call back number is gonna be [PII].
[AGENT][NEUTRAL] Mhm.
[AGENT][POSITIVE] Perfect.
[CUSTOMER][NEUTRAL] And that is my direct line.
[AGENT][POSITIVE] Awesome and then what's that policy number we're looking at?
[CUSTOMER][NEUTRAL] And then looks like the policy, uh huh it's gonna be 01826054.
[AGENT][POSITIVE] Perfect. And give me just a moment to get that loaded.
[CUSTOMER][NEUTRAL] Sure.
[AGENT][NEUTRAL] All right, Ms. [PII]. I appreciate your patience. If you could verify your insured's first and last name and date of birth.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Yeah, it looks like the patient's name is [PII] [PII].
[AGENT][NEUTRAL] Perfect. I do see [PII] right here. It looks like he's current and active with an effective date of [PII]. And then for benefits are we looking for inpatient or outpatient today?
[CUSTOMER][NEUTRAL] They'll be outpatient for an MRI.
[AGENT][POSITIVE] Perfect. And
[AGENT][NEUTRAL] I do want to let you know any benefits given over the phone today. It's just a verification of coverage and not a guarantee of payment.
[AGENT][NEUTRAL] It looks like his outpatient benefits he has a.
[AGENT][NEUTRAL] Let me just open this up.
[AGENT][NEUTRAL] All right, so it looks like he has a.
[AGENT][NEUTRAL] Outpatient inpatient combined maximum, so they're together for $4000 per calendar year. Um, if he is outpatient and the reason is due to an accident, um, rather than sickness, he does have a $1000 deductible.
[CUSTOMER][NEUTRAL] OK, so let's see, let me look up the account. Let me see what he's here for.
[CUSTOMER][NEUTRAL] So looks like this was on his plan that he had an MRI done in [PII], so I don't know if he actually has.
[CUSTOMER][NEUTRAL] Another accident or whatever the case may be.
[AGENT][NEUTRAL] Oh, and actually, um, this bar wasn't open all the way, so he actually has just a deductible outpatient for accident and sickness. So that 1000 would be.
[AGENT][NEUTRAL] it would be the whole thing so he just has an outpatient deductible of $1000.
[CUSTOMER][NEUTRAL] OK, just in general.
[AGENT][NEUTRAL] Yes, yeah, um, that tab wasn't pulled all the way over, so it just cut off after the accident.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] Um, and it doesn't appear that he's used any of his benefits for the [PII] calendar year.
[CUSTOMER][NEUTRAL] OK, and so he said he had a $1000 deductible. What about out of pocket?
[AGENT][NEUTRAL] Um, because for secondary, we don't have like any of that. Um, we just try to help cover, uh, their out of pocket costs for major medicals, so we're kind of like a gap insurance for them.
[CUSTOMER][NEUTRAL] Got you, so no copay, no co-insurance or anything?
[AGENT][NEUTRAL] Mm.
[CUSTOMER][NEUTRAL] All right. OK. Then may I just have a name and a reference number for this uh call, please?
[AGENT][NEUTRAL] You betcha. My name is [PII], first initial last name, [PII], and then the reference number is my name and today's date.
[CUSTOMER][POSITIVE] Perfect.
[CUSTOMER][NEUTRAL] All right.
[CUSTOMER][POSITIVE] OK, well you have a great rest of your day and I appreciate your help.
[AGENT][POSITIVE] Thank you so much you have a good one and thank you for calling APL.
[CUSTOMER][POSITIVE] Thank you you too bye.