AccountId: 011433970860
ContactId: 3b3d09f6-e291-4899-befa-b915d33e36b5
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 213830 ms
Total Talk Time (AGENT): 100388 ms
Total Talk Time (CUSTOMER): 75299 ms
Interruptions: 0
Overall Sentiment: AGENT=0.7, CUSTOMER=1
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/02/12/3b3d09f6-e291-4899-befa-b915d33e36b5_20250212T13:55_UTC.wav
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[AGENT][NEUTRAL] Thank you for calling APL. This is [PII]. How can I help you?
[CUSTOMER][NEUTRAL] Hi, I am calling to get I guess eligibility and benefits for a patient that stated they have this insurance as a gap insurance.
[AGENT][NEUTRAL] OK, and may I have your name?
[CUSTOMER][NEUTRAL] My name is [PII].
[AGENT][NEUTRAL] [PII] thank you and you also have your call back number if we are disconnected?
[CUSTOMER][NEUTRAL] [PII]
[AGENT][NEUTRAL] Thank you and may I have the policy number please?
[CUSTOMER][NEUTRAL] I have it as 02455090.
[AGENT][NEUTRAL] And just let me repeat that to you please. I have that as 02455090.
[CUSTOMER][POSITIVE] Correct.
[AGENT][NEUTRAL] Verify the patient's name and date of birth.
[CUSTOMER][NEUTRAL] I have it as [PII].
[AGENT][NEUTRAL] Verify the patient's name and date of birth.
[CUSTOMER][NEUTRAL] Uh, let me go back to that.
[CUSTOMER][NEUTRAL] Date of birth is [PII].
[AGENT][NEUTRAL] OK, you said that was [PII]?
[CUSTOMER][POSITIVE] Correct.
[CUSTOMER][NEUTRAL] Oh, I'm so sorry. I'm giving you the wrong date of birth. My apologies, I'm on the wrong.
[CUSTOMER][POSITIVE] Give me one moment, I thought I'm on the wrong patient. I'm so sorry about that.
[AGENT][NEUTRAL] Oh.
[CUSTOMER][NEUTRAL] No, her date of birth. Her date of birth is [PII]. My apologies.
[AGENT][NEUTRAL] OK, no problem, thank you for that information verifying that. Thank you and again you're calling for inpatient, excuse me, outpatient benefits or inpatient?
[CUSTOMER][NEUTRAL] I guess inpatient work. I'm calling from a doctor's office.
[AGENT][NEUTRAL] OK, so outpatient. OK, give me one second please. Her policy shows effective as of [PII] and it shows active as her supplemental or gap, and let me check for benefits for an office setting. One moment please, [PII].
[CUSTOMER][NEUTRAL] Perfect. And would I be able to give you the MPI to make sure that we that we're in network with this insurance? This is one that I've not come across personally.
[AGENT][NEUTRAL] We are a secondary, so that means that she has a major medical. We do not have a network of providers and as her supplemental or gap, what we do is help with her major medical deductible copay or co-insurance.
[CUSTOMER][POSITIVE] Got you.
[AGENT][POSITIVE] I'm still looking for a benefit for you so I'm sorry.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] She does not have a benefit to cover for an office visit fee that could be with a PCP or a specialist. She does have a benefit to help with, excuse me, procedures inside the office.
[AGENT][NEUTRAL] And that is covered up to the outpatient max.
[CUSTOMER][NEUTRAL] OK, so this
[AGENT][NEUTRAL] Yes ma'am, so not the office visit but.
[CUSTOMER][NEUTRAL] OK, sorry, I'm just writing down, yeah, so not the office visit procedures, yes, OK.
[AGENT][NEUTRAL] That's OK.
[AGENT][POSITIVE] Yes, so let me get that outpatient benefit one moment thank you.
[CUSTOMER][NEUTRAL] Got it.
[CUSTOMER][NEUTRAL] The office procedures as a yes.
[AGENT][NEUTRAL] Yes, of course, and that's for covered services and we'll pay up to $3150 for the calendar year. Um, please note verification of benefits provided does not guarantee payment.
[CUSTOMER][NEUTRAL] Mm
[CUSTOMER][NEUTRAL] And then may I have a reference number for this call?
[AGENT][NEUTRAL] It will be my name [PII] last initial [PII], and today's date.
[CUSTOMER][POSITIVE] Alright, thank you so much I appreciate your help, [PII].
[AGENT][POSITIVE] You're welcome, [PII], and thank you for calling APL. Have a good day bye.
[CUSTOMER][NEUTRAL] You too bye.