AccountId: 011433970860
ContactId: 3dbfa729-1d2d-4300-8efa-c0887e875061
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 319450 ms
Total Talk Time (AGENT): 126854 ms
Total Talk Time (CUSTOMER): 89436 ms
Interruptions: 1
Overall Sentiment: AGENT=0.8, CUSTOMER=1.1
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/03/06/3dbfa729-1d2d-4300-8efa-c0887e875061_20250306T19:15_UTC.wav
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[AGENT][NEUTRAL] Thank you for calling APL. This is [PII]. How may I help you?
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] Sorry, my name is [PII], and I'm calling from Medpas urgent care and I'm trying to verify benefits and coverage for a patient.
[AGENT][NEUTRAL] OK, I can help you with benefits and eligibility for a patient, Ms. [PII]. Can I please get your callback number just in case the call gets disconnected?
[CUSTOMER][NEUTRAL] Sure, it's [PII].
[AGENT][NEUTRAL] OK, thank you. And what is the patient's name, date of birth, and policy number?
[CUSTOMER][NEUTRAL] OK, policy number is gonna be a chore because I don't see one on here, but her, the name is [PII]. Her date of birth is [PII].
[CUSTOMER][NEUTRAL] Um, I see it says coverage individual. I see group number, uh, then it goes down it says in hospitals benefit certification number and outpatient benefit certification number.
[AGENT][NEUTRAL] OK, if you can give me one of those inpatient or outpatient cert numbers that's the policy number.
[CUSTOMER][NEUTRAL] Oh, OK. 024.
[CUSTOMER][NEUTRAL] 934.
[CUSTOMER][NEUTRAL] 75, M as in Mary, L as in like, 8.
[AGENT][NEUTRAL] OK let me look that up real quick for.
[AGENT][NEUTRAL] OK, I do show that [PII] does have an active policy. She, her effective date is [PII].
[AGENT][NEUTRAL] And this is just to verify her benefits. It's not a guarantee of payment.
[AGENT][NEUTRAL] She has an inpatient calendar year benefit amount of $2000. This is a supplemental insurance policy that helps with deductible, co-pay, or co-insurance. And then she also has an outpatient benefit amount per calendar year of $2000.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] OK, so is she eligible to visit an urgent care center?
[AGENT][NEUTRAL] Let me pull her policy up and read that real quick to see if urgent care centers a facility that she can go to.
[CUSTOMER][NEUTRAL] Is that covered?
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] It's gonna be just a moment while this pulls in.
[CUSTOMER][POSITIVE] Oh, take your time.
[AGENT][POSITIVE] Thank you.
[CUSTOMER][NEUTRAL] Mm
[AGENT][NEUTRAL] OK, a covered outpatient facility?
[AGENT][NEUTRAL] Is a free-standing outpatient surgery center, hospital emergency room, hospital outpatient facility, MRI facility, physical therapy, or urgent care center?
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] OK, um, does she have, does she have a copay or anything at urgent care?
[AGENT][NEUTRAL] Yes.
[AGENT][NEUTRAL] Let me look.
[CUSTOMER][NEUTRAL] Because this looks like an insurance that we don't, I don't, I've never seen this before. I don't know if.
[AGENT][NEUTRAL] She does not. Um, so this, this policy actually helps with deductible, co-pay or coinsurance only.
[CUSTOMER][NEUTRAL] OK, I'm, I'm, I'm OK, so is there another insurance that goes along with this, or this is in addition to other insurance?
[AGENT][NEUTRAL] This is billed secondary to her primary.
[CUSTOMER][NEUTRAL] OK, because she told me this is the only one that she has.
[AGENT][NEUTRAL] So her primary EOB will need to be sent with the claim.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] All right.
[CUSTOMER][NEUTRAL] OK, and can I get a reference number?
[AGENT][NEUTRAL] Yes ma'am, you can use my name [PII] and today's date.
[CUSTOMER][NEUTRAL] OK, what's the first name again?
[AGENT][NEUTRAL] [PII]
[CUSTOMER][NEUTRAL] OK, and 03.
[CUSTOMER][NEUTRAL] 0625, correct?
[AGENT][NEUTRAL] Yes.
[CUSTOMER][POSITIVE] OK, thank you.
[AGENT][POSITIVE] You're very welcome you have a good day. We appreciate you calling Miss [PII]. Is there anything else that I can help you with before we hang up?
[CUSTOMER][POSITIVE] Alrighty thank you.
[CUSTOMER][POSITIVE] No ma'am, thank you.
[AGENT][POSITIVE] OK, thank you. Bye-bye.
[CUSTOMER][NEUTRAL] Bye bye.