AccountId: 011433970860
ContactId: 2abd9f93-a0d6-48b3-89a2-a5851d656f4b
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 252639 ms
Total Talk Time (AGENT): 126171 ms
Total Talk Time (CUSTOMER): 71537 ms
Interruptions: 0
Overall Sentiment: AGENT=2, CUSTOMER=0.7
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/06/18/2abd9f93-a0d6-48b3-89a2-a5851d656f4b_20250618T18:30_UTC.wav
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[AGENT][NEUTRAL] Good afternoon. Thank you for calling APL. This is [PII]. How may I assist you?
[CUSTOMER][NEUTRAL] Hi, yeah, I'm calling to check or uh get benefits and eligibility for one of our patients, please.
[AGENT][POSITIVE] OK, sure, I can assist you with benefits and eligibility. May I have your name?
[CUSTOMER][NEUTRAL] Sure, my name is [PII].
[AGENT][NEUTRAL] OK, and Miss [PII], may I have a callback number just in case we get disconnected?
[CUSTOMER][NEUTRAL] Sure it's [PII].
[AGENT][NEUTRAL] OK, thank you. And may I have the patient's policy number?
[CUSTOMER][NEUTRAL] I have 01828765.
[AGENT][NEUTRAL] All right, thank you. And may I have the name of the facility that you're calling from for my notes?
[CUSTOMER][NEUTRAL] Uh-huh. It's uh Saint Louis Dermatology and Cosmetic Surgery.
[AGENT][NEUTRAL] OK, thank you. May I have the name and date of birth of the patient?
[CUSTOMER][NEUTRAL] Sure. It's [PII]. Date of birth is [PII].
[AGENT][POSITIVE] Perfect, thank you. And you say you need benefits and eligibility. What type of services being rendered?
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][POSITIVE] I believe he's gonna be coming in for.
[CUSTOMER][NEUTRAL] Um, let's see, he's, he's gonna be coming in for an exit, uh, done in the office.
[AGENT][NEUTRAL] Mm yeah.
[AGENT][NEUTRAL] And that's a, um, so it's gonna be like a small surgery and
[AGENT][NEUTRAL] Let's see.
[CUSTOMER][NEUTRAL] Yeah.
[AGENT][NEUTRAL] OK. And is um medically necessary, correct? Not cosmetology.
[CUSTOMER][NEUTRAL] Right.
[AGENT][POSITIVE] No. OK. All right. All right. Thank you.
[AGENT][NEUTRAL] Before I give you any benefit information, I need to let you know that this is not a guarantee of payment, just a verification of coverage. We have an effective date of [PII]. It is active at the moment and this is one of our secondary supplemental plans for the major medical.
[AGENT][NEUTRAL] And see, we do cover office procedures. Office procedures are subject to the outpatient maximum and outpatient deductible. The maximum benefit is 5000 per covered person per calendar year after a 1000 deductible.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK. And uh what did you say about the max? Is it uh out of pocket?
[AGENT][NEUTRAL] No, it's just a maximum benefit that we cover. We help with the co-payments, deductibles and co-insurance from the major medical. So we cover up to $5000 for any outpatient service after a $1000 deductible.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK, got it. All right.
[AGENT][NEUTRAL] Is there anything else that I'll help you with today Miss [PII]?
[CUSTOMER][NEUTRAL] All right. So since it's a secondary, it's just um gonna pick up the
[CUSTOMER][NEUTRAL] Whatever it um the the the.
[AGENT][NEUTRAL] All right. What we do is we help with the deductibles, co-payment, and car insurance. So as long as the major medical applied and approved those amounts towards the deductible co-payment and co-insurance, that's what we take care of.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][POSITIVE] All right. Um, I think that's all that I needed. Thank you so much.
[AGENT][POSITIVE] You're welcome. Is there anything else I may help you with today?
[CUSTOMER][NEUTRAL] Um,
[CUSTOMER][POSITIVE] That's all. Thank you.
[AGENT][POSITIVE] Yeah. You're welcome. Thank you for calling APL. Have a good afternoon.
[CUSTOMER][NEUTRAL] You too bye bye.
[AGENT][POSITIVE] Thank you. Bye-bye.