AccountId: 011433970860
ContactId: 2ca0f61d-e7e1-4838-8c1d-a109840ba3ca
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 360609 ms
Total Talk Time (AGENT): 137952 ms
Total Talk Time (CUSTOMER): 78893 ms
Interruptions: 0
Overall Sentiment: AGENT=0.2, CUSTOMER=1.2
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/02/06/2ca0f61d-e7e1-4838-8c1d-a109840ba3ca_20250206T16:35_UTC.wav
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[AGENT][NEUTRAL] Thank you for calling APL. This is [PII]. How may I help you?
[CUSTOMER][NEUTRAL] Yes ma'am, um, this is [PII] with Saints Medical Group. Uh, we have a patient who is gonna be coming in for an in office procedure. Um, I just wasn't 100% sure how her.
[CUSTOMER][NEUTRAL] How this plan worked because she does have a primary um so I didn't know like if she had to meet her deductible before y'all pick up or not.
[AGENT][NEUTRAL] Mhm.
[AGENT][NEUTRAL] OK, alright, Miss [PII], I can help you with the benefits for the patient uh can I please get your call back number just in case our call is disconnected?
[CUSTOMER][NEUTRAL] Yes ma'am, [PII], and that's a direct line.
[AGENT][NEUTRAL] OK, thank you. What's the patient's name?
[CUSTOMER][NEUTRAL] It is [PII] and then [PII]
[AGENT][NEUTRAL] OK, thank you so much. And then what is the patient's date of birth?
[CUSTOMER][NEUTRAL] It is [PII].
[AGENT][NEUTRAL] OK, and patients policy number please?
[CUSTOMER][NEUTRAL] It is 01792105.
[AGENT][NEUTRAL] OK, let me look that up real quick.
[AGENT][NEUTRAL] OK, I do show that her policy is active and her effective date is [PII].
[AGENT][NEUTRAL] And this is a supplemental insurance policy you're correct that um is billed secondary to the primary, so the primary billed first and this is just to verify her coverage it's not a guarantee of payment.
[AGENT][NEUTRAL] After the primary has been billed and you get the EOB back then you'll send us a claim for secondary to help with deductible co-pay or co-insurance.
[AGENT][NEUTRAL] And it's based on what primary covers uh she does have an inpatient.
[AGENT][NEUTRAL] Calendar year benefit amount of $5000.
[AGENT][NEUTRAL] And then she also has an outpatient calendar year benefit amount of $5000.
[AGENT][NEUTRAL] Um,
[AGENT][NEUTRAL] So let me see.
[AGENT][NEUTRAL] If the office visits are covered for this policy.
[AGENT][NEUTRAL] OK, I'm gonna go ahead and pull the policy up itself and read it and see what it says about office visits and approved facilities for that.
[CUSTOMER][NEUTRAL] OK
[AGENT][NEUTRAL] It's gonna be
[AGENT][NEUTRAL] So the computer has to search for it and download it and then I have to read it so I just wanna let you know it's gonna be just a minute.
[CUSTOMER][POSITIVE] Oh that's fine thank you.
[AGENT][NEUTRAL] OK. You're welcome. I just wanna make sure.
[AGENT][NEUTRAL] OK, so no, it does not have the physician's office visit fee. It's not covered on the policy.
[CUSTOMER][NEUTRAL] OK, and then if it's just for um a procedure, would that be covered?
[AGENT][NEUTRAL] Let me look see.
[AGENT][NEUTRAL] For accident or sickness.
[CUSTOMER][NEUTRAL] Um,
[CUSTOMER][NEUTRAL] I know it wouldn't be for.
[AGENT][NEUTRAL] That's those
[AGENT][NEUTRAL] That's what it covers is for accident or sickness. That's the benefit. So it's the procedure if it's for accident or sickness.
[CUSTOMER][NEUTRAL] I don't know if that would fall under either of those, OK.
[CUSTOMER][NEUTRAL] OK, maybe.
[CUSTOMER][NEUTRAL] Alright perfect and then um is there a call reference number?
[AGENT][NEUTRAL] Oh yes, ma'am. You can use my name. It's [PII], and today's date.
[CUSTOMER][POSITIVE] OK awesome thank you so much for your help I appreciate it.
[AGENT][POSITIVE] You're very welcome, Miss [PII]. I hope you have a great day and I appreciate you calling APL today.
[CUSTOMER][POSITIVE] Thank you ma'am you too bye bye.
[AGENT][NEUTRAL] Bye-bye, ma'am.