AccountId: 011433970860
ContactId: 3c52ee32-cca2-49fe-b387-3e2b34ab9d33
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 227440 ms
Total Talk Time (AGENT): 118593 ms
Total Talk Time (CUSTOMER): 103705 ms
Interruptions: 2
Overall Sentiment: AGENT=0.9, CUSTOMER=0.8
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/01/27/3c52ee32-cca2-49fe-b387-3e2b34ab9d33_20250127T20:45_UTC.wav
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[AGENT][POSITIVE] Thank you for calling APL this is [PII]. How can I help you?
[CUSTOMER][NEUTRAL] Hi, I was calling to get the the injury date of well the benefits and eligibility of [PII].
[AGENT][NEUTRAL] OK, can I get your name please?
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] OK, [PII], can I get a good call back number?
[CUSTOMER][NEUTRAL] Um, the number is.
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] OK, thank you, [PII]. Can I get the policy number?
[CUSTOMER][NEUTRAL] It's 02465058.
[AGENT][NEUTRAL] 65058. OK. And um [PII], repeat that insured's name for me and the date of birth.
[CUSTOMER][NEUTRAL] [PII] [PII].
[AGENT][NEUTRAL] OK, thank you. You said you're calling to get eligibility and benefits, is that correct?
[CUSTOMER][NEUTRAL] Yes ma'am.
[AGENT][POSITIVE] OK, I can definitely take a look um.
[CUSTOMER][NEUTRAL] That at the same time I don't remember it [PII] at [PII].
[AGENT][POSITIVE] Now, it looks like [PII] was effective with his [PII] and currently still active.
[CUSTOMER][NEUTRAL] You
[AGENT][NEUTRAL] Bear with me here while I pull up the benefits now is this for inpatient or outpatient?
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Wednesday.
[CUSTOMER][NEUTRAL] This is for inpatient.
[AGENT][NEUTRAL] Inpatient, OK, so this will be a verification of benefits and not a guarantee of payment.
[CUSTOMER][NEUTRAL] And
[CUSTOMER][NEUTRAL] Copy of that.
[AGENT][NEUTRAL] Um, inpatient, let's see here, the inpatient is $2000 per covered person per calendar year.
[CUSTOMER][NEUTRAL] See what he saw.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] And a maximum of $6000 per covered person for all covered persons combined.
[CUSTOMER][POSITIVE] Thanks.
[AGENT][NEUTRAL] And that is the inpatient benefits.
[CUSTOMER][NEUTRAL] OK, um, do you know the date of his injury?
[AGENT][NEUTRAL] Um, that is not.
[AGENT][NEUTRAL] Let's see here.
[CUSTOMER][NEUTRAL] No.
[CUSTOMER][NEUTRAL] Yeah I'm sorry, so don't apologize.
[AGENT][NEUTRAL] OK, it doesn't look like I have a HIPAA on file to release that information to you guys.
[CUSTOMER][NEUTRAL] Alright
[CUSTOMER][NEUTRAL] Yep, and we need to find out if it covers for he has a primary does what does this cover for secondary? OK, um, and his secondary is the APL?
[AGENT][NEUTRAL] Yes, ma'am. This is a um Medlink policy, so it's a secondary supplemental policy.
[CUSTOMER][NEUTRAL] Yeah, we'll just
[CUSTOMER][NEUTRAL] OK, um, so I, I'm sorry, I was trying to get his, his, what his co-pay or co-insurances and his out of pocket max, that's 6000.
[AGENT][NEUTRAL] OK, so on the policy, let's see here, let me go back to it. There's not gonna be a co-pay or co-insurance. This policy will pick up the deductible copay and co-insurance from the primary insurance up to that amount. Um, let me get back to it.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][POSITIVE] Yes ma'am, sorry about that. That's what we're needing. She's new, so she, this is, I kind of threw her in the wolves. I apologize.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] No, I completely understand. Um, so the inpatient benefit, the policy will pay $2000 per cover person per calendar year up to a maximum of $6000 per per calendar year for all covered persons combined.
[CUSTOMER][NEUTRAL] OK, um, do they have any accumulations as of right now?
[AGENT][NEUTRAL] Yes, ma'am.
[AGENT][NEUTRAL] For [PII]?
[CUSTOMER][NEUTRAL] Yes ma'am.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] For 2025, any claims that we have processed, there's no accumulations, but that is not included any outstanding claims that we haven't received and processed.
[CUSTOMER][POSITIVE] Alright, that's all we needed thank you so very much.
[AGENT][POSITIVE] OK, well if there's nothing else I hope you have a great day and thank you for calling APL.
[CUSTOMER][POSITIVE] Thank you, have a nice one.
[AGENT][NEUTRAL] Uh-huh. Bye-bye.