AccountId: 011433970860
ContactId: 3b363906-c1cf-404f-bbed-29e0511f06d5
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 225860 ms
Total Talk Time (AGENT): 93487 ms
Total Talk Time (CUSTOMER): 58126 ms
Interruptions: 0
Overall Sentiment: AGENT=0.7, CUSTOMER=1.6
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/02/04/3b363906-c1cf-404f-bbed-29e0511f06d5_20250204T17:34_UTC.wav
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[AGENT][NEUTRAL] Thank you for calling APL. This is [PII]. How may I help you?
[CUSTOMER][NEUTRAL] Hi, [PII]. This is [PII] calling from Doctor [PII]'s office. I was needing to check a patient's benefits um for outpatient injections and to see if there's any off requirements.
[AGENT][NEUTRAL] OK, Ms. [PII], I can help you with um outpatient benefits. Uh, can you please give me your callback number just in case our call is disconnected?
[CUSTOMER][NEUTRAL] Yes, it's [PII].
[AGENT][NEUTRAL] Thank you. And then what is the patient's name?
[CUSTOMER][NEUTRAL] Uh [PII].
[AGENT][NEUTRAL] OK, and then the patient's date of birth.
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] And patient's policy number?
[CUSTOMER][NEUTRAL] 01902342.
[AGENT][NEUTRAL] OK, let me look that up real quick.
[AGENT][NEUTRAL] OK, I do show that [PII] does have an active policy. Her effective date is [PII].
[AGENT][NEUTRAL] And this is just to verify her coverage. It's not a guarantee of payment. This is a supplemental insurance policy that's billed secondary to the primary. It helps with deductible, co-pay and co-insurance only. Um, she has an inpatient calendar year benefit amount of $5000 and then she also has an outpatient calendar year benefit amount of $100.
[AGENT][NEUTRAL] And then she does have an ER deductible of 300.
[CUSTOMER][NEUTRAL] Has anything been met with those out of pockets?
[AGENT][NEUTRAL] Let me look for you real quick.
[AGENT][NEUTRAL] No, ma'am. Nothing has been used.
[AGENT][NEUTRAL] For the year of [PII].
[CUSTOMER][NEUTRAL] OK. And you said
[CUSTOMER][NEUTRAL] You said inpatient was 5000 and outpatient was 100?
[AGENT][NEUTRAL] Let me look again.
[AGENT][NEUTRAL] No, outpatient was 1000.
[CUSTOMER][NEUTRAL] Oh, OK.
[CUSTOMER][NEUTRAL] So with this being a supplement plan, you guys would follow Medicare guidelines, right?
[AGENT][NEUTRAL] No, we file, we follow our own guidelines, um.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] You just, yeah, would for the policy contract.
[CUSTOMER][NEUTRAL] OK. Can you check to see if we need authorization for these injections?
[AGENT][NEUTRAL] You do not need authorization because we're not the primary insurance.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][POSITIVE] All right, thank you so much. Can I get a reference number from you?
[AGENT][NEUTRAL] Yes ma'am, you can use my name it's [PII] in today's date.
[CUSTOMER][POSITIVE] OK. Thank you, [PII]. You have a great day.
[AGENT][POSITIVE] You too, [PII]. Thanks for calling APL. I hope you have a wonderful day also.
[AGENT][POSITIVE] You take care.
[CUSTOMER][POSITIVE] Thank you. Bye-bye.
[AGENT][NEUTRAL] Bye bye.