AccountId: 011433970860
ContactId: 30619ed5-ede9-4d83-848e-d581d23fe3af
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 288500 ms
Total Talk Time (AGENT): 88202 ms
Total Talk Time (CUSTOMER): 124105 ms
Interruptions: 0
Overall Sentiment: AGENT=1.1, CUSTOMER=0.3
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/05/07/30619ed5-ede9-4d83-848e-d581d23fe3af_20250507T13:41_UTC.wav
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[AGENT][NEUTRAL] Thank you for calling APL. This is [PII]. How can I help you?
[CUSTOMER][NEUTRAL] Hi, this is [PII] calling from office to check eligibility and benefits.
[AGENT][POSITIVE] Hi [PII], I can help you with eligibility and benefits. Do you have a good callback number?
[CUSTOMER][NEUTRAL] Yeah, my callback number will be [PII] and it's a direct line.
[AGENT][NEUTRAL] Policy number of the patient?
[CUSTOMER][NEUTRAL] Yeah, the policy number will be 60801 and the patient's first name is spelled as [PII] and the last name is spelled as [PII] and the date of birth will be [PII].
[AGENT][NEUTRAL] Um, that policy number you gave us is our payer ID. Do you have a different policy number?
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] Yeah, I do see that outpatient benefit certification number is that?
[AGENT][NEUTRAL] Yes.
[CUSTOMER][NEUTRAL] Yeah, that will be 2, sorry, 0248.
[CUSTOMER][NEUTRAL] 1560 M as in Mike L as in Lima 8.
[AGENT][NEUTRAL] OK, it looks like this policy is effective for 1-2024. It's currently active. There's no term date.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] And is it for outpatient benefit?
[CUSTOMER][NEUTRAL] And could you help me with the planting?
[CUSTOMER][NEUTRAL] Yeah, this is for the outpatient laboratory services.
[AGENT][NEUTRAL] That's.
[CUSTOMER][NEUTRAL] I would like to know about the plan type.
[AGENT][NEUTRAL] The secondary policy.
[CUSTOMER][NEUTRAL] Mhm. May I know the plan date?
[AGENT][NEUTRAL] Secondary.
[CUSTOMER][NEUTRAL] No, it's like in PPR HMO or supplement policy.
[AGENT][NEUTRAL] It's not a PPO or HMO. It's a secondary policy.
[CUSTOMER][NEUTRAL] Then it is a supplement policy, right?
[AGENT][NEUTRAL] Yes.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK. Does the patient have any co-pay coinsurance deductible for individual and family out of pocket for individual and family?
[AGENT][NEUTRAL] Um, this is not a guarantee of payment. It's a basic outline of the policy.
[AGENT][NEUTRAL] Let me pull that up. One moment.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][POSITIVE] Mhm take your time.
[AGENT][NEUTRAL] There's no deductible. The plan will pay up to $3000 per calendar year.
[AGENT][NEUTRAL] After primary has processed the claim, that would pay for deductible, co-pay, and co-insurance of primary.
[AGENT][NEUTRAL] Up to 3000.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK, detectable is 3000, right?
[AGENT][NEUTRAL] No.
[AGENT][NEUTRAL] The plan will pay 3000. There's no deductible?
[CUSTOMER][NEUTRAL] And
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] So after primary processes the claim, anything that's left over, any balance left over from primary, this plan pays that up to 3000.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] OK. Uh, does the patient have any out of pocket maximum?
[AGENT][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] OK, mm.
[CUSTOMER][NEUTRAL] Uh, OK. As we out of network laboratory service authorization is required, right?
[AGENT][NEUTRAL] I'm sorry?
[CUSTOMER][NEUTRAL] Authorization does not require rate as we out of network laboratory services.
[AGENT][NEUTRAL] No authorization is required.
[CUSTOMER][NEUTRAL] OK, were you able to check any that authorization has been initiated?
[AGENT][NEUTRAL] There's no authorization required.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK, could you help me with your name? Can you spell your name for me, please?
[AGENT][NEUTRAL] [PII], it's [PII]
[CUSTOMER][NEUTRAL] And first initial to your last name?
[AGENT][NEUTRAL] [PII].
[CUSTOMER][NEUTRAL] OK, and could you help me with the call reference number for this call?
[AGENT][NEUTRAL] It's my name is [PII] plus today's date.
[CUSTOMER][NEUTRAL] OK, I would like to double check it again. The effective date will be [PII]. This is supplementary policy.
[AGENT][POSITIVE] Yes, that's correct.
[CUSTOMER][NEUTRAL] Primary page.
[CUSTOMER][NEUTRAL] Uh, after the primary page, uh, if it has something left over, you'll be able to pay up to $3000 and authorization does not required, and your name is spelled as [PII] and first initial your last name is [PII] and the call reference number will be your name and today's date, right?
[AGENT][POSITIVE] Yes, that's correct.
[CUSTOMER][POSITIVE] OK, thank you for your assistance. Have a great day.
[AGENT][POSITIVE] Thanks for calling APL. You as well. Bye bye.