AccountId: 011433970860
ContactId: 3b2b56ee-407f-469e-9bfd-c25512de6958
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 291700 ms
Total Talk Time (AGENT): 94653 ms
Total Talk Time (CUSTOMER): 107417 ms
Interruptions: 0
Overall Sentiment: AGENT=0.4, CUSTOMER=0.6
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/03/25/3b2b56ee-407f-469e-9bfd-c25512de6958_20250325T19:02_UTC.wav
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[AGENT][NEUTRAL] Thank you for calling APL. This is [PII]. How can I help you?
[CUSTOMER][NEUTRAL] Hey [PII], no. Hi [PII], this is [PII]. I'm calling from a doctor's office. I need to check eligibility on a patient that's having a procedure, please.
[AGENT][NEUTRAL] OK, [PII], I can help you with eligibility. Do you have a good call back number?
[CUSTOMER][NEUTRAL] Sure, it's [PII].
[AGENT][POSITIVE] OK, thank you.
[AGENT][NEUTRAL] Do you have the policy number of the patient?
[CUSTOMER][POSITIVE] You're welcome.
[CUSTOMER][NEUTRAL] Yes, uh, let me see.
[CUSTOMER][NEUTRAL] He, he will have to be against the outpatient benefit. It's 01570123.
[CUSTOMER][NEUTRAL] Mm 08.
[AGENT][NEUTRAL] Do you have a patient name and date of birth?
[CUSTOMER][NEUTRAL] [PII] date of birth is [PII].
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] Um, he has a more recent policy, but it looks like it's dropped as well, um.
[AGENT][NEUTRAL] Uh, it looks like it terminated on [PII].
[CUSTOMER][NEUTRAL] So her
[CUSTOMER][NEUTRAL] They terminated on [PII], OK.
[CUSTOMER][NEUTRAL] [PII].
[CUSTOMER][NEUTRAL] Um,
[CUSTOMER][NEUTRAL] And, and she didn't renew to, to a new policy?
[AGENT][NEUTRAL] Um, let me see here. I don't think so. Let me double check one thing. Oh, here we go. Sorry about that.
[AGENT][NEUTRAL] Mm.
[AGENT][NEUTRAL] OK, actually it, yes, she's got a new policy this one is active, um it looks like let me give you that policy number.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Um,
[CUSTOMER][NEUTRAL] What's the policy number?
[AGENT][NEUTRAL] It's 240-8806.
[CUSTOMER][NEUTRAL] 240
[CUSTOMER][NEUTRAL] 88806.
[AGENT][NEUTRAL] And then let's see, effective [PII].
[CUSTOMER][NEUTRAL] [PII].
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] And do you need benefits?
[CUSTOMER][NEUTRAL] I, I need to know, um,
[CUSTOMER][NEUTRAL] She's having a procedure. AsMed is, is, is a primary insurance, and, and you guys are, are her secondary. I need to know if, um, because her, her insurance card doesn't say whether she has a deductible or not, or if you guys pick up the deductible from her primary insurance.
[AGENT][NEUTRAL] OK, let me see, this is not a guarantee of payments basic outline of the policy, um, we do coordinate benefits as a secondary with the primary, so the policy would potentially pay for deductible, co-pay and co-insurance, and you said it's an outpatient procedure.
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] Right.
[CUSTOMER][NEUTRAL] Yes, it's a colonoscopy and an endoscopy.
[AGENT][NEUTRAL] OK. Is that diagnostic?
[CUSTOMER][NEUTRAL] Yeah.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] Um, for her outpatient benefit, she has a $1000 calendar year, uh, maximum.
[AGENT][NEUTRAL] Pay out, there's no deductible.
[CUSTOMER][NEUTRAL] There's no so, so her, so there's no deductible, there's no out of pocket, um.
[CUSTOMER][NEUTRAL] So her deductible from her primary insurance is not matched. So whatever they don't pay you guys pick it up?
[AGENT][NEUTRAL] We, we would pay up to her policy maximum benefit of 1000 based on what the primary insurance pays.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK, got it.
[CUSTOMER][NEUTRAL] Um,
[CUSTOMER][NEUTRAL] But, and she doesn't need an offering.
[AGENT][NEUTRAL] No, no authorizations required.
[CUSTOMER][NEUTRAL] OK, and do you have a reference number for this call, please, [PII]?
[AGENT][NEUTRAL] Um, reference number would just be my first name, last initial, it's [PII], and then D as in dog, today's date. And is there anything else I can help with today?
[CUSTOMER][POSITIVE] No, that's all, [PII]. Thank you so much.
[AGENT][POSITIVE] OK thank you [PII] have a great day and thank you for calling APL.
[CUSTOMER][POSITIVE] Thank you you too bye.
[AGENT][NEUTRAL] Bye.