AccountId: 011433970860
ContactId: 3dd0a474-346a-47d9-9c33-f8f6129fe34f
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 585059 ms
Total Talk Time (AGENT): 251515 ms
Total Talk Time (CUSTOMER): 113639 ms
Interruptions: 0
Overall Sentiment: AGENT=0.5, CUSTOMER=0.4
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/02/19/3dd0a474-346a-47d9-9c33-f8f6129fe34f_20250219T21:38_UTC.wav
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[AGENT][NEUTRAL] Thank you for calling APL. This is [PII]. How may I help you?
[CUSTOMER][NEUTRAL] Um, yes, I was just calling to get benefits for a patient. My name is [PII].
[AGENT][POSITIVE] OK, I can help you, Tren to get benefits for our patient. Can I please get your callback number just in case our call is disconnected?
[CUSTOMER][NEUTRAL] OK, it is [PII].
[AGENT][POSITIVE] Thank you. And what is the name of your facility?
[CUSTOMER][NEUTRAL] Dutch Medical clinics.
[AGENT][POSITIVE] OK, thank you so much. And can I get the patient's name, date of birth, and policy number?
[CUSTOMER][NEUTRAL] OK, her name is [PII]. Date of birth [PII] and policy number is.
[CUSTOMER][NEUTRAL] 01890013
[AGENT][NEUTRAL] OK, let me look that up real quick.
[AGENT][NEUTRAL] OK, I do show that [PII] does have an active policy with us. Her effective date is [PII].
[AGENT][NEUTRAL] And this is just to verify her benefits. It doesn't guarantee payment.
[AGENT][NEUTRAL] She has a supplemental insurance policy that is a gap insurance. It helps with deductible, co-pay, and co-insurance.
[AGENT][NEUTRAL] She has an inpatient benefit amount per calendar uh let's see.
[AGENT][NEUTRAL] OK, she has the benefit amount per calendar year of $2500 and then she has an outpatient.
[AGENT][NEUTRAL] Benefit of $2000.
[CUSTOMER][NEUTRAL] You know
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] And is there a when you say that's how much y'all will pay out for a calendar year?
[AGENT][NEUTRAL] Yes, ma'am. Yes, ma'am.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] And has she accumulated anything towards those?
[AGENT][NEUTRAL] Let me look real quick.
[AGENT][NEUTRAL] No, ma'am, she has not used anything for the year of [PII].
[CUSTOMER][NEUTRAL] OK, and is there a deductible she needs to make before y'all start paying?
[AGENT][NEUTRAL] Let me check on this policy. I don't believe there is, but I wanna double check myself.
[AGENT][NEGATIVE] No deductible.
[CUSTOMER][NEUTRAL] No coinsurance you'll just pay out until you reach that max and then patient responsibility.
[AGENT][NEUTRAL] Yes.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Alright.
[CUSTOMER][NEUTRAL] Um, believe that is this for um.
[CUSTOMER][NEUTRAL] Is this just for hospital or is this physician fee too?
[AGENT][NEUTRAL] It's just for um outpatient services and for accident or sickness.
[AGENT][NEUTRAL] Um, in an out, uh, in a hospital outpatient facility for the outpatient benefits and then.
[AGENT][NEUTRAL] Inpatient would be 18 hours or more for the hospital itself.
[CUSTOMER][NEUTRAL] OK, so you'll only pay to the facility and not the physician.
[CUSTOMER][NEUTRAL] So the patient is gonna be having.
[AGENT][NEUTRAL] Well, it depends on what to go.
[CUSTOMER][NEUTRAL] The patient's gonna be having a baby, so it will be inpatient, um, but of course, we will build the actual delivery and then the hospital will build the anesthesia and all the other stuff. So.
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] She will be inpatient, but we will be doing the delivery. So is that pay towards us or does it pay just to the hospital?
[AGENT][NEUTRAL] No
[AGENT][NEUTRAL] Let me check real quick. I'm gonna pull her policy up and read it.
[AGENT][NEUTRAL] And see what it says about the physician's fee.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Sure.
[AGENT][NEUTRAL] It's gonna be just a second while it loads and then I'll have to scroll through and find it.
[AGENT][NEUTRAL] It's gonna be just a moment.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] OK, let me see.
[AGENT][NEUTRAL] OK. And I'm glad I looked at this because um it has a maximum inhospital benefit, and this is what it states. If the um
[AGENT][NEUTRAL] In hospital benefit is $2000 or less.
[AGENT][NEUTRAL] The insured pays a $100 deductible and then 20% co-insurance for the 1st $5000 of covered charges per calendar year person.
[AGENT][NEUTRAL] Uh, $2,0001 to $2750 250 dollars deductible, then 20% co-insurance for the 1st $10,000 of covered charges per calendar year per person on the policy.
[AGENT][NEUTRAL] Uh, $2,751 to $4250 is a $500 deductible, then $200 and then 20% co-insurance for the 1st $10,000.
[AGENT][NEUTRAL] Of the cover charges per calendar year per person and then there's one more for $4,251 or more, it's a $1000 deductible and then 20% co-insurance for the 1st $10,000 of the cover charges per calendar year per person.
[AGENT][NEUTRAL] Um, I'm looking to see again about the physician's fee.
[AGENT][NEUTRAL] If that's covered or.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] And I got the $2000 or less with the $5000 deductible and 80/20 coinsurance. What was the next deductible?
[AGENT][NEUTRAL] Yes.
[AGENT][NEUTRAL] Oh, let me go back up, hold on, let me find it again.
[CUSTOMER][NEUTRAL] I'm sorry.
[AGENT][NEUTRAL] That's OK.
[CUSTOMER][NEUTRAL] Mhm
[AGENT][NEUTRAL] Um, for 2001 to 2750.
[AGENT][NEUTRAL] It's $250 deductible then 20%.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] Up to 10,000.
[AGENT][NEUTRAL] 2,751 to 4250 is $500 deductible, then 20% up to $10,000.
[CUSTOMER][NEUTRAL] Got it.
[AGENT][NEUTRAL] And then
[AGENT][NEUTRAL] $4,251 or more is $1000 deductible then 20% up to $10,000.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] OK. Now, let me see about that physician's fee.
[AGENT][NEUTRAL] Yeah, this policy just covers hospital.
[CUSTOMER][NEUTRAL] I'm sorry, the phone cut out. You said it just covers what?
[AGENT][NEUTRAL] Hospital.
[CUSTOMER][NEUTRAL] OK, so it doesn't pay out the position.
[AGENT][NEUTRAL] Right.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Well that is what I needed to know then.
[AGENT][NEUTRAL] OK.
[CUSTOMER][POSITIVE] Yes ma'am, well that's it. Well, thank you so much.
[AGENT][POSITIVE] You're very welcome. I hope you have a good rest of your day, Ms. [PII], and thank you so much for calling APL.
[CUSTOMER][POSITIVE] Thank you you as well.
[AGENT][NEUTRAL] Mm bye-bye, ma'am.
[CUSTOMER][NEUTRAL] Mm bye bye.