AccountId: 011433970860
ContactId: 2ec008b2-48a3-4dc8-9b6c-dbe1da1966e6
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 131360 ms
Total Talk Time (AGENT): 89931 ms
Total Talk Time (CUSTOMER): 30334 ms
Interruptions: 0
Overall Sentiment: AGENT=3.4, CUSTOMER=1.5
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/01/27/2ec008b2-48a3-4dc8-9b6c-dbe1da1966e6_20250127T14:52_UTC.wav
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[AGENT][POSITIVE] Good morning. Thank you for calling APL. This is [PII]. How may I help you today?
[CUSTOMER][NEUTRAL] Hi, my name is [PII]. I'm calling to get benefits and eligibility on a patient, please.
[AGENT][POSITIVE] Yes, ma'am. [PII], I'll be glad to help you. Go ahead and give me your policy number, please.
[CUSTOMER][NEUTRAL] Policy number is 02337128.
[AGENT][POSITIVE] Alrighty, [PII], thank you so much for that information. Now while I'm pulling this up, go ahead and give me a good return telephone call number, please.
[CUSTOMER][NEUTRAL] [PII].
[AGENT][POSITIVE] Alrighty [PII], thank you so much for that information and what's your patience name and date of birth today please ma'am?
[CUSTOMER][NEUTRAL] It is [PII]. Date of birth is [PII].
[AGENT][NEUTRAL] All righty, [PII], thank you for all that information. Looks like [PII] is the insured on this medical supplemental plan. I do show the original effective date is [PII]. Patient is still current and active, but I must advise the verification of coverage is not a guarantee of payment on the claim, but you did say you want some type of benefit. Is that correct?
[CUSTOMER][NEUTRAL] Outpatient benefit please.
[AGENT][NEUTRAL] All right, let me get that pulled up. Let's see.
[AGENT][NEUTRAL] Now what we are, of course, it's her medical supplemental plan, so the only thing that we would pick up and pay on is anything for sickness and injury that is applied towards her deductible copay or co-insurance at her primary insurance carrier. Now her outpatient benefits here is no pre-cert.
[AGENT][NEUTRAL] She has a 0 deductible and $1000 payable per calendar year.
[AGENT][NEUTRAL] If she did go to the emergency room, she does have a $500 deductible to meet here first.
[CUSTOMER][NEUTRAL] OK, and of that $1000 for the year, [PII], um, how much is she used?
[AGENT][NEUTRAL] Let's see if we have paid anything, no claims owner as of today paid.
[CUSTOMER][NEUTRAL] You know
[CUSTOMER][POSITIVE] Perfect. That was all I needed. Thank you so much for your help though and have a wonderful day.
[AGENT][POSITIVE] Well, you as well then [PII], if that's all I can help answer for you. Thanks for calling APO and you have a great rest of your Monday.
[CUSTOMER][POSITIVE] Thank you you too goodbye.
[AGENT][POSITIVE] Yes, ma'am. Thank you, ma'am. Bye-bye.