AccountId: 011433970860
ContactId: 37728648-1fb4-47e9-95fc-e2a9bb5629db
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 351839 ms
Total Talk Time (AGENT): 115410 ms
Total Talk Time (CUSTOMER): 162514 ms
Interruptions: 2
Overall Sentiment: AGENT=0.3, CUSTOMER=0.3
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/01/02/37728648-1fb4-47e9-95fc-e2a9bb5629db_20250102T15:12_UTC.wav
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[AGENT][POSITIVE] Good morning. Thank you for calling IPL. This is [PII]. May I help you?
[CUSTOMER][NEUTRAL] Uh yeah. Hi [PII]. This is [PII]. I'm calling from Nicholas Chin's Hospital and this call is regarding for the patient eligibility and the benefits information, so please help me with that.
[AGENT][NEUTRAL] OK. Do you have a phone number I can get in case we get disconnected I can call you back?
[CUSTOMER][NEUTRAL] Uh yeah, sure. The callback number is [PII].
[CUSTOMER][NEUTRAL] Uh,
[CUSTOMER][NEUTRAL] Give me a moment. Yeah, it's sorry, it's.
[CUSTOMER][NEUTRAL] [PII]
[AGENT][NEUTRAL] And do you have the policy number?
[CUSTOMER][NEUTRAL] Yeah, sure.
[CUSTOMER][NEUTRAL] The policy number is 01845832 M as in Mike L as in Lima 8.
[AGENT][NEUTRAL] And the patient's name?
[CUSTOMER][NEUTRAL] Patient first name is [PII] and the last name is [PII].
[AGENT][NEUTRAL] Date of birth?
[CUSTOMER][NEUTRAL] Date of birth is [PII].
[AGENT][NEUTRAL] Thank you, [PII], and you were just needing benefits?
[CUSTOMER][NEUTRAL] No, actually, I'm looking for the eligibility and the benefits for the medical.
[AGENT][NEUTRAL] OK, I can help you with that. Um, is it for outpatient inpatient or doctor's office?
[CUSTOMER][NEUTRAL] Uh, this is for the outpatient office visits for the specialist visits, general benefits.
[AGENT][NEUTRAL] For what, what benefits?
[CUSTOMER][NEUTRAL] Office specialist visits, outpatient office.
[AGENT][NEUTRAL] OK, but it's an office visit you're calling about?
[CUSTOMER][NEUTRAL] Yes, specialist visits.
[AGENT][NEUTRAL] OK. Any benefits given over the phones, not a guarantee of payment. The effective date was [PII].
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] Office visit
[CUSTOMER][NEUTRAL] [PII] or 20.
[AGENT][NEUTRAL] Uh-huh. Office visits are not covered under this policy.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] So, what, what policies covered?
[AGENT][NEUTRAL] What does it cover?
[CUSTOMER][NEUTRAL] Means inpatient, uh, means outpatient visit, it's not covered, right? Outpatient office visit, it's not covered.
[AGENT][NEGATIVE] It is not covered.
[CUSTOMER][NEUTRAL] And this
[CUSTOMER][NEUTRAL] So, is it inpatient? was uh the policies covered?
[AGENT][NEUTRAL] M
[AGENT][NEUTRAL] Right, inpatient and outpatient facilities, but it does not cover outpatient office visits.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] So what policies cover uh for this patient?
[AGENT][NEUTRAL] Their policy doesn't cover outpatient office visits.
[AGENT][NEUTRAL] It covers outpatient facility like MRI diagnostic centers, outpatient hospital.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK. Give me a moment.
[AGENT][NEUTRAL] It does not cover office visits at all.
[CUSTOMER][NEUTRAL] Give me a moment.
[CUSTOMER][NEUTRAL] Office visits.
[CUSTOMER][NEUTRAL] Only covered outpatient hospital, right?
[AGENT][NEUTRAL] Outpatient hospital, MRI diagnostic centers.
[CUSTOMER][NEUTRAL] Yeah
[CUSTOMER][NEUTRAL] OK, for the outpatient hospital, the, this is the alternative benefits, right?
[AGENT][NEUTRAL] This policy coordinates with the primary insurance, whatever the primary applies to their deductible copay or co-insurance for covered services under our policy.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] So the American public, this is a secondary?
[AGENT][NEUTRAL] Yes.
[CUSTOMER][NEUTRAL] OK. So who is the primary? Is there any, uh, I mean.
[CUSTOMER][NEUTRAL] Information you have?
[AGENT][NEUTRAL] I'm not sure who their primary is.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] So, the um uh for the secondary insurance, it's covered only for the primary, uh, the, the primary insurance benefits, right?
[AGENT][NEUTRAL] Right, it coordinates with the primary insurance. We only pick up what the primary applies to their deductible co-pay or co-insurance.
[CUSTOMER][NEUTRAL] But
[CUSTOMER][NEUTRAL] OK. If the, if the primary policy is inactive, then what two means, what policy you covered? Because, yeah.
[AGENT][NEUTRAL] If this, if primary doesn't pay, we do not pay.
[CUSTOMER][NEUTRAL] OK, primary doesn't pay, you do not pay, right? OK. Because I, because I, uh, because I checked for the USC uh the, the PPO, but I think uh the USC, uh, plan is not active, so that's why I called for the secondary.
[AGENT][POSITIVE] Correct.
[AGENT][NEUTRAL] OK, if it's not active, then they shouldn't have this policy because they have to have a uh primary to have this policy.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] OK. You covered only for the primary, primary policy.
[AGENT][NEUTRAL] Right.
[CUSTOMER][NEUTRAL] OK, um, [PII], your name is [PII]. Um, uh, OK, [PII], could you please provide the call number of this call?
[AGENT][NEUTRAL] We do not have call reference numbers. You can use my name and today's date.
[CUSTOMER][POSITIVE] OK, not an issue. Thank you so much, [PII]. Thanks for the assistance. Have a wonderful day. Bye-bye.
[AGENT][POSITIVE] Thank you, [PII], for calling APLU as well.
[AGENT][NEUTRAL] Bye bye.
[CUSTOMER][POSITIVE] Thank you so much bye bye.