AccountId: 011433970860
ContactId: 3bf79d91-1ca4-4675-9118-e0a3a0cf4a93
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 244550 ms
Total Talk Time (AGENT): 121479 ms
Total Talk Time (CUSTOMER): 80910 ms
Interruptions: 1
Overall Sentiment: AGENT=0.6, CUSTOMER=0
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/01/13/3bf79d91-1ca4-4675-9118-e0a3a0cf4a93_20250113T17:10_UTC.wav
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[AGENT][NEUTRAL] Hi, thank you for calling APL. This is [PII]. How can I help you today?
[AGENT][NEUTRAL] Hello.
[CUSTOMER][NEUTRAL] Oh, I, I was on mute. I'm sorry. Hi, this is [PII] from thank you and I'm looking for as you benefits and authorization requirement.
[AGENT][NEUTRAL] No, that's OK.
[AGENT][POSITIVE] OK, perfect. I'd love to help you with that today. And do you mind if I grab a good phone number for you, my friend?
[CUSTOMER][NEUTRAL] Yeah, the call is [PII].
[CUSTOMER][NEUTRAL] And you said your name is [PII].
[AGENT][NEUTRAL] [PII].
[AGENT][NEUTRAL] It's [PII], first initial last name, [PII].
[CUSTOMER][NEUTRAL] Yeah.
[AGENT][NEUTRAL] And then [PII], do you mind if I also get the policy number for your patient?
[CUSTOMER][POSITIVE] Thank you.
[CUSTOMER][NEUTRAL] Alright remember I for today it is.
[CUSTOMER][NEUTRAL] 02403932
[AGENT][POSITIVE] OK, perfect. Give me just a moment to get that policy pulled up.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] Perfect. And can you verify for me, please, your your patient's first and last name and date of birth?
[CUSTOMER][NEUTRAL] My name is [PII]. Date of birth [PII].
[AGENT][NEUTRAL] Perfect. Your patient is current and active. It looks like she has an effective date of [PII], and you said you're looking for benefits as well today. Are we looking at inpatient and outpatient benefits?
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Outpatient for DME.
[AGENT][NEUTRAL] For DME OK, let me pull that up.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] I'd like to check our network status as well.
[AGENT][NEUTRAL] OK, yeah, we're actually her secondary insurance we're kind of like a gap insurance so we're just gonna follow her major medical, um, so we don't require pre-authorization and whatever network her major medicals and we're gonna follow right behind it.
[AGENT][NEUTRAL] Um, it does look like your patient has an outpatient calendar year benefit of $4000 and then it does look like she has a rider for DME.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] So the name is covered basically it.
[AGENT][NEUTRAL] Uh, yeah, she has a writer for DME.
[CUSTOMER][NEUTRAL] OK, and is there any deductibles and out of pockets, especially?
[AGENT][NEUTRAL] Um, she does not have a deductible with us, no, because we're her secondary.
[CUSTOMER][NEUTRAL] OK, out of pocket as well, so this 4000 is.
[CUSTOMER][NEUTRAL] Exactly what amount is it? What does it represent?
[AGENT][NEUTRAL] Well, it's uh $4000 per person per calendar year is the amount of benefits she can receive with us. Um, we will, what we do is we work to help um with charges applied to the co-pay co-insurance or deductible left behind from her major medical, uh, for accidents or sickness.
[CUSTOMER][NEUTRAL] Oh, OK. OK.
[CUSTOMER][NEUTRAL] And nothing has been made yet.
[AGENT][NEUTRAL] Um, yeah, let me take a look at her calendar year benefits. We're quite new into the calendar year, but.
[AGENT][NEUTRAL] Um, I'll take a look at that for you.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] I don't see anything under [PII].
[CUSTOMER][NEGATIVE] And this is the out of network benefits that is said there is no in network benefits.
[AGENT][NEUTRAL] There's no what?
[CUSTOMER][NEGATIVE] There's no in network benefits.
[AGENT][NEUTRAL] No, we don't have in out work out network benefits. We just follow major medical.
[CUSTOMER][POSITIVE] OK, alright, thank you.
[CUSTOMER][NEUTRAL] And what would be the reference number please?
[AGENT][NEUTRAL] You bet you. Um, it's gonna be my name [PII], first initial last name, [PII] in today's date.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][POSITIVE] Alright, appreciate your patience and time and uh have a good day.
[AGENT][POSITIVE] Hey, it's my pleasure you too, thanks for calling the APL and you take care.
[CUSTOMER][NEUTRAL] Yeah bye.
[AGENT][NEUTRAL] Bye bye.