AccountId: 011433970860
ContactId: 37200cd6-6a45-4377-9ed5-de6ff1c569a5
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 213630 ms
Total Talk Time (AGENT): 99940 ms
Total Talk Time (CUSTOMER): 73103 ms
Interruptions: 0
Overall Sentiment: AGENT=1.3, CUSTOMER=0.6
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/03/04/37200cd6-6a45-4377-9ed5-de6ff1c569a5_20250304T13:35_UTC.wav
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[AGENT][POSITIVE] Good morning. Thank you for calling APL. My name is [PII]. How may I help you?
[CUSTOMER][NEUTRAL] Good morning. My name is [PII]. I'm calling from.
[CUSTOMER][NEUTRAL] The talks too. I'm trying to see if we take this insurance plan.
[AGENT][NEUTRAL] OK, um, I can definitely look at the coverage with you, [PII]. May I have a good contact number in case we're disconnected and the policy number?
[CUSTOMER][NEUTRAL] Yes, the contact number is [PII].
[CUSTOMER][NEUTRAL] [PII]
[CUSTOMER][NEUTRAL] And
[CUSTOMER][NEUTRAL] The policy number is
[CUSTOMER][NEUTRAL] Oh, I'm looking at their insurance but I'm trying to see.
[AGENT][NEUTRAL] Um, it should say inhospital or outpatient policy er number.
[CUSTOMER][NEUTRAL] Is it
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] So then it's 019.
[CUSTOMER][NEUTRAL] 913.
[CUSTOMER][NEUTRAL] 40
[CUSTOMER][NEUTRAL] M as in Mary. L as in Larry 8.
[AGENT][NEUTRAL] Thank you for that. And can you verify the member's first and last name and date of birth?
[CUSTOMER][NEUTRAL] Yes.
[CUSTOMER][NEUTRAL] It is gonna be for [PII]. Last name is [PII] Date of birth is [PII].
[AGENT][NEUTRAL] Thank you for that and all the information provided is a verification of benefits, not a guarantee of payment. So I am showing the policy is active. It's been effective since [PII]. And let me see what type of policy. So this is a secondary policy, um, so there's no network or anything. We apply to the co-pay, deductible and co-insurance after their primary, which for this policy is Cigna. So there's no
[AGENT][NEUTRAL] Uh, like in-network or out of network with the secondary policy.
[CUSTOMER][NEUTRAL] So, do you, um, do you pick up after Cigna?
[AGENT][NEUTRAL] Right, we pay towards the coke.
[CUSTOMER][NEUTRAL] So like right now.
[CUSTOMER][NEUTRAL] Yeah, they have a $400 co-pay for surgery.
[CUSTOMER][NEUTRAL] So would you guys pick up like they wouldn't have to pay anything? You guys would cover them?
[AGENT][NEUTRAL] So everything we do is on the back end once the claim is filed. So if anything is required upfront, they'll have to make that payment to get the services. So their benefit, um, well, are you considered outpatient?
[CUSTOMER][NEUTRAL] Well, they're having surgery, so they're the service being performed as outpatient.
[AGENT][NEUTRAL] OK, so for outpatient, the benefit is up to $500 per occurrence. So, um, whatever the co-pay is, once we get the explanation of benefits from primary and the itemized bill, we can determine if the insurer needs to be reimbursed or if there's something still owed to you, but it would be up to that $500.
[AGENT][NEUTRAL] Per current.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] All right, and then can I just get a reference number?
[AGENT][NEUTRAL] Sure, so there's no call reference number, but you can use my name in today's date. The first initial to my last name is [PII].
[CUSTOMER][NEUTRAL] And what was your first name?
[AGENT][NEUTRAL] My name is [PII]
[CUSTOMER][NEUTRAL] Alright, so you guys pay up to 500 anything exceeding 500, the patient would be responsible for?
[AGENT][NEUTRAL] We don't determine patient responsibility, um, it would be whatever your policies are for outstanding balances if there is one.
[CUSTOMER][POSITIVE] OK, alright, thank you so much.
[AGENT][POSITIVE] You're very welcome and thanks for calling APL. I hope you have a great day.
[CUSTOMER][POSITIVE] Thanks you too. Bye-bye.
[AGENT][POSITIVE] Thank you. Bye-bye.