AccountId: 011433970860
ContactId: 29c66fc1-5edf-4537-bc7a-3b3d073587bd
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 323320 ms
Total Talk Time (AGENT): 141087 ms
Total Talk Time (CUSTOMER): 115550 ms
Interruptions: 0
Overall Sentiment: AGENT=1.8, CUSTOMER=1.5
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/02/05/29c66fc1-5edf-4537-bc7a-3b3d073587bd_20250205T21:37_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] Hi, yes, I'm calling from Doctor Close's office. I'm calling in regards to a patient, um, to verify their benefit details.
[AGENT][POSITIVE] It would be my pleasure to assist you. Did you just call and ask me to wait a minute? I think we got disconnected.
[CUSTOMER][NEUTRAL] Yeah, yeah.
[AGENT][NEUTRAL] OK, good. I'm glad you called back. I was like, oh no, they're not there.
[AGENT][NEUTRAL] What is your name, please?
[CUSTOMER][POSITIVE] Thank you.
[CUSTOMER][NEUTRAL] Yes, my name is [PII]
[AGENT][POSITIVE] Thank you, [PII], and a good call back number please.
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] Thank you, [PII]. And what is the policy number for the patient?
[CUSTOMER][NEUTRAL] Yes, I have 15493.
[AGENT][NEUTRAL] That's gonna be the group number. Do you see a policy cert number at the bottom?
[AGENT][NEUTRAL] Of the card. Do you have an APL?
[CUSTOMER][NEUTRAL] Oh, that's
[CUSTOMER][NEUTRAL] Let me see if we have it here scanned give me one second.
[AGENT][POSITIVE] Take your time.
[CUSTOMER][NEUTRAL] All right.
[CUSTOMER][NEUTRAL] I have a uh yeah benefit certificate number.
[AGENT][NEUTRAL] That's it, yes, ma'am.
[CUSTOMER][NEUTRAL] OK, it is 01933929 M as in Mary, [PII].
[AGENT][NEUTRAL] Thank you and the patient's name and date of birth please, ma'am?
[CUSTOMER][NEUTRAL] Yes, of course, patient's name is [PII] Last name is [PII].
[AGENT][NEUTRAL] And date of birth.
[CUSTOMER][NEUTRAL] Date of birth is [PII].
[AGENT][POSITIVE] All right, thank you. [PII], I'd be happy to assist you with eligibility and benefits.
[AGENT][NEUTRAL] I'm showing [PII]'s policy is active with the effective date of [PII].
[AGENT][NEUTRAL] This is a secondary policy to her the policyholder's primary insurance.
[AGENT][NEUTRAL] And what type of benefits are you needing?
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Um, for medical, the patient had a surgery done. Let me give you the exact date.
[CUSTOMER][NEUTRAL] They had a surgery on [PII] here in [PII]. Um, do you want the um CBT code?
[AGENT][NEUTRAL] No, that's fine. Have you all submitted the claim or you just need the benefits?
[CUSTOMER][NEUTRAL] Um, we have not submitted a claim, um, the mom, which is the policyholder, she just gave us, um, the card for, um, APL.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] Yeah, and was that for outpatient services or inpatient?
[CUSTOMER][NEUTRAL] Inpatient.
[AGENT][NEUTRAL] OK. Well, [PII] does have benefits for an inpatient hospital stay, and I can provide those benefits if you'd like.
[CUSTOMER][POSITIVE] OK, yes please.
[AGENT][NEUTRAL] [PII], her inpatient hospital benefits is $7900 per calendar year.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] That is a verification of coverage, not a guarantee of payment, and that is what we can pay toward the deductible, co-pay or co-insurance of the major medical.
[CUSTOMER][NEUTRAL] Alright.
[AGENT][NEUTRAL] And
[AGENT][NEUTRAL] As of right now, she has used $2,949.87 of that benefit.
[CUSTOMER][NEUTRAL] Alright, you said 2000 and how much? I'm sorry?
[AGENT][NEUTRAL] $2,494.87.
[CUSTOMER][POSITIVE] Perfect.
[AGENT][POSITIVE] And anything else I can help you with today?
[CUSTOMER][NEUTRAL] They don't have some sort of co-payment, right?
[AGENT][NEUTRAL] Not on the APL policy.
[CUSTOMER][POSITIVE] Perfect.
[CUSTOMER][NEUTRAL] Alright, and can you give me outpatient as well just in case?
[AGENT][NEUTRAL] Sure, it is the same, $7900 per calendar year.
[CUSTOMER][NEUTRAL] OK, and they met the same amount correct?
[AGENT][NEUTRAL] have not used any of their benefits for outpatient for [PII].
[CUSTOMER][POSITIVE] OK perfect.
[CUSTOMER][POSITIVE] All right, thank you so much. Can I have a reference number?
[AGENT][POSITIVE] Reference number is my name and today's date, and I spell my name [PII], and it was such a pleasure to assist you with that benefit. Anything else I can help you with?
[CUSTOMER][POSITIVE] No, that'll be it thank you so much.
[AGENT][POSITIVE] And thank you for calling APL. I hope you have a wonderful day.
[CUSTOMER][NEUTRAL] You too bye bye.
[AGENT][POSITIVE] Thank you, [PII]. Bye-bye.