AccountId: 011433970860
ContactId: 3c12583b-5563-4de7-9ce6-c14d4de52a70
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 330070 ms
Total Talk Time (AGENT): 145108 ms
Total Talk Time (CUSTOMER): 129504 ms
Interruptions: 2
Overall Sentiment: AGENT=0.3, CUSTOMER=1
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/03/24/3c12583b-5563-4de7-9ce6-c14d4de52a70_20250324T17:14_UTC.wav
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[AGENT][NEUTRAL] Thank you for calling APL. This is [PII]. How may I help you?
[CUSTOMER][NEUTRAL] Hi, my name is [PII]. I'm calling for an uh Macula to get some benefits for a patient, please.
[AGENT][NEUTRAL] Yes ma'am, this is with APL. How may I help you today?
[CUSTOMER][NEUTRAL] Hi, can you hear me?
[AGENT][NEUTRAL] I can hear you.
[CUSTOMER][POSITIVE] Oh OK, calling to get some benefits for uh patients.
[AGENT][POSITIVE] OK, I can help you with benefits. Can I please get your name and your callback number?
[CUSTOMER][POSITIVE] Thank you.
[CUSTOMER][NEUTRAL] [PII]
[CUSTOMER][NEUTRAL] My name is [PII] [PII].
[AGENT][NEUTRAL] OK, Ms. [PII], what is the name?
[CUSTOMER][NEUTRAL] Name of the patient?
[CUSTOMER][NEUTRAL] Hello, hello, hello?
[AGENT][NEUTRAL] Hello, I can hear you. What is the name of the facility you're calling for?
[CUSTOMER][NEUTRAL] OK, OK, yeah.
[CUSTOMER][NEUTRAL] Retina macula.
[AGENT][NEUTRAL] Macula. OK, thank you. And then can I get the patient's name, date of birth, and policy number?
[CUSTOMER][NEUTRAL] Sure, policy number it says 01611835 Febroniolancio.
[CUSTOMER][NEUTRAL] Date of birth, it's [PII].
[AGENT][POSITIVE] OK, thank you so
[AGENT][NEUTRAL] Give me just a moment. Let me look up that policy number.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][POSITIVE] Sure, thank you.
[AGENT][NEUTRAL] OK. I do show that Fabronio does have an active policy with us and his effective date is [PII].
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Oh, OK.
[AGENT][NEUTRAL] Just to benefits, it's not a guarantee payment. He has a supplemental insurance policy that's billed secondary to the primary. It, it's a gap insurance that helps with deductible, co-pay and co-insurance.
[CUSTOMER][NEUTRAL] Hm.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] He has an inpatient.
[CUSTOMER][NEUTRAL] OK, so if the patient, uh huh, OK, sorry.
[AGENT][NEUTRAL] He has inpatient benefit amount of $2500 and he has an outpatient benefit amount of $1500 per calendar year.
[CUSTOMER][NEUTRAL] Mm, OK, and if he has a copay from the primary insurance, will this cover?
[AGENT][NEUTRAL] Yes, this is to help with deductible, co-pay or co-insurance.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Oh, coin insurance.
[CUSTOMER][NEUTRAL] And deductible, OK.
[CUSTOMER][NEUTRAL] I have a question, um, does the website, um, we can use the website to check on the benefits or no?
[AGENT][NEUTRAL] If you have filed a right, if you have filed a claim for him in the past.
[CUSTOMER][NEUTRAL] A portal.
[AGENT][NEUTRAL] Then you can, but if you've never filed a claim for him, then you wouldn't be able to, um, and.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Mm.
[AGENT][NEUTRAL] You can file the claim.
[CUSTOMER][NEUTRAL] Uh-huh.
[CUSTOMER][NEUTRAL] Probably there is a claim he was, he was seeing, he was seeing um.
[AGENT][NEUTRAL] Same up.
[CUSTOMER][NEUTRAL] On February, so that's basically a claim now?
[AGENT][NEUTRAL] Uh-huh.
[AGENT][NEUTRAL] Uh, did you guys file a claim for him in February?
[CUSTOMER][NEUTRAL] So I will be able to see.
[CUSTOMER][NEUTRAL] Yes.
[AGENT][NEUTRAL] From your facility?
[CUSTOMER][POSITIVE] Correct.
[AGENT][NEUTRAL] Let me look real quick.
[CUSTOMER][NEUTRAL] Meeting you mean like billed from the visit?
[AGENT][NEUTRAL] Right.
[CUSTOMER][NEUTRAL] Is that what it is? OK, yeah, yeah, I'm pretty sure it says build.
[AGENT][NEUTRAL] Right, right. Did you send it and I'm showing that.
[AGENT][NEUTRAL] Yes, and I'm showing that his policy, his account number for patient account number for you is 05833179.
[AGENT][NEUTRAL] 7520-1, is that correct?
[CUSTOMER][NEUTRAL] Um, yes.
[AGENT][NEUTRAL] OK, yes ma'am, if you file the claim with us you should be able to go in the portal and put in that um patient account number.
[AGENT][NEUTRAL] And um you, you know, you should be able to find it that way after the claim is processed.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Oh OK, where it says patient account number?
[AGENT][NEUTRAL] Yes.
[CUSTOMER][NEUTRAL] OK, let me repeat the number [PII].
[AGENT][NEUTRAL] Yes, the first part that before the 83 will be 05.
[CUSTOMER][NEUTRAL] Oh [PII].
[CUSTOMER][NEUTRAL] 205.
[AGENT][NEUTRAL] No, just 05.
[CUSTOMER][NEUTRAL] Oh, OK.
[CUSTOMER][NEUTRAL] Oh
[AGENT][NEUTRAL] It's your account number that your hospital assigned to them or your office assigned to them.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Oh yeah, it's OK.
[CUSTOMER][NEUTRAL] Oh OK, OK, can I have a reference number for the call?
[AGENT][NEUTRAL] Yes, ma'am. You can use my name [PII] in today's date.
[CUSTOMER][POSITIVE] Perfect.
[CUSTOMER][POSITIVE] Thank you, [PII]. Have a great day.
[CUSTOMER][POSITIVE] Take care bye bye thank you.