AccountId: 011433970860
ContactId: 29cc54c9-390b-4888-bd6b-bea365b6af0f
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 197539 ms
Total Talk Time (AGENT): 108844 ms
Total Talk Time (CUSTOMER): 61580 ms
Interruptions: 0
Overall Sentiment: AGENT=2.5, CUSTOMER=0.2
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/03/18/29cc54c9-390b-4888-bd6b-bea365b6af0f_20250318T13:36_UTC.wav
--------------------------------------------
[AGENT][POSITIVE] Good morning. Thank you for calling APL. My name is [PII]. How may I help you?
[CUSTOMER][NEUTRAL] Hi, I have a patient coming in and I just need to see what her insurance covers.
[AGENT][POSITIVE] Well, it would be my pleasure to assist you. May I ask your name?
[CUSTOMER][NEUTRAL] My name is [PII].
[AGENT][POSITIVE] Thank you, [PII] and what is a good callback number in case we get disconnected?
[CUSTOMER][NEUTRAL] [PII]
[AGENT][NEUTRAL] Thank you, [PII] and the policy number for the patient, please?
[CUSTOMER][NEUTRAL] Um 02424886 ML 8.
[AGENT][NEUTRAL] Thank you, [PII]. And what is the patient's name and date of birth, please?
[CUSTOMER][NEUTRAL] [PII] and [PII].
[AGENT][NEUTRAL] All right, I can assist you with eligibility and benefits for [PII]. I'm showing that her policy is active. Effective date is [PII], and this is a secondary policy to the policyholder's major medical.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] And you said she's coming in. Her policy is active. Do you need benefits as well?
[CUSTOMER][NEUTRAL] Yes.
[AGENT][NEUTRAL] And for what type of service?
[CUSTOMER][NEUTRAL] Um, I need to see if the office visit and an ultrasound done in office are covered.
[AGENT][POSITIVE] All right. I can help you with that benefit.
[AGENT][NEUTRAL] Now, for the office visit co-pay, she does not have coverage.
[AGENT][NEUTRAL] She does have benefits for any procedures or treatments such as diagnostic testing in office, and that benefit amount is $6000 per calendar year.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] That we can pay to the deductible, co-pay or co-insurance of her major medical. Now that is a verification of coverage, not a guarantee of payment.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] And then does she have any coverage for preventative services?
[AGENT][NEUTRAL] Preventative is not covered under this secondary gap policy.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] So just the diagnostic would be covered and you guys pay up to 6000.
[AGENT][POSITIVE] That's correct.
[CUSTOMER][NEUTRAL] OK. Has she met anything of it?
[AGENT][NEUTRAL] As of right now for [PII], she has that full benefit remaining. She's not used any of it as of yet.
[CUSTOMER][NEUTRAL] OK, and then I'm guessing since it's gap it doesn't have like a deductible or out of pocket, it's just the 6000.
[AGENT][POSITIVE] That is correct.
[CUSTOMER][NEUTRAL] OK, if I could just get you to spell your name and a reference number, please?
[AGENT][NEUTRAL] Sure, well, the reference number you can use my name and today's date, and I spell my name [PII].
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][POSITIVE] And [PII], it was a pleasure to assist you with that eligibility and benefits for [PII]. Anything else I can help you with today?
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][POSITIVE] That was all. Thank you.
[AGENT][POSITIVE] And thank you for calling APL. I hope you have a wonderful day.
[CUSTOMER][NEUTRAL] You too. Bye-bye.
[AGENT][NEUTRAL] Bye-bye.