AccountId: 011433970860
ContactId: 3f606dac-035b-408c-8498-04bdda4cc9da
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 449529 ms
Total Talk Time (AGENT): 156553 ms
Total Talk Time (CUSTOMER): 186759 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/2025/02/06/3f606dac-035b-408c-8498-04bdda4cc9da_20250206T16:21_UTC.wav
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[AGENT][NEUTRAL] Thank you for calling APL this is [PII]. How may I help you?
[CUSTOMER][NEUTRAL] And then
[CUSTOMER][POSITIVE] Uh, yes, I, I'm calling to get benefits for a member.
[AGENT][POSITIVE] OK, I can help you with benefits. Can I please get your name and your callback number?
[CUSTOMER][NEUTRAL] He
[CUSTOMER][NEUTRAL] [PII] [PII].
[CUSTOMER][NEUTRAL] If we removed it
[AGENT][NEUTRAL] OK, Miss [PII], what is the name of the facility you're calling from?
[CUSTOMER][NEUTRAL] Signature Women's Healthcare or Vital MD?
[AGENT][NEUTRAL] OK, thank you, ma'am. And then what is the patient's name?
[CUSTOMER][NEUTRAL] [PII].
[CUSTOMER][NEUTRAL] Mm.
[CUSTOMER][NEUTRAL] And her birthday is [PII].
[AGENT][NEUTRAL] OK, and then what is your policy number please?
[CUSTOMER][NEUTRAL] 02141142 M as in Mary, L as in Lima number 8.
[AGENT][NEUTRAL] OK, let me pull in her policy for us real quick.
[CUSTOMER][NEUTRAL] in you.
[CUSTOMER][NEUTRAL] And then so we get a biop
[AGENT][NEUTRAL] OK, I do show that [PII] does have an active policy. Her effective date is [PII].
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] And this is just just to verify her coverage it's not a guarantee of payment. She does have a supplemental insurance policy that is a gap insurance. It's billed secondary. It helps with deductible, co-pay and co-insurance.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] She has an inpatient calendar year benefit amount of $2500 and then she also has an outpatient calendar year benefit amount of $1250.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK, and can you give me benefits for a specific CPT code, or do you just get general benefits?
[AGENT][NEUTRAL] Um, it's, it's done by what the primary pays, um, for deductible, co-pay or co-insurance.
[CUSTOMER][NEUTRAL] And
[CUSTOMER][NEUTRAL] OK, so let's say she doesn't have, let's say she hasn't met her deductible with her primary insurance.
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] And she has to pay out of pocket, would you, would this kick in after the the primary?
[AGENT][NEUTRAL] Mhm.
[AGENT][NEUTRAL] Right.
[AGENT][NEUTRAL] Yes, ma'am.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] So, OK, I'm sorry, could you repeat the what what you said initially so I can.
[AGENT][NEUTRAL] Yes, OK, so, um, and this is just to verify her coverage. It's not a guarantee of payment. She has an inpatient calendar year benefit amount of $2500 and she has an outpatient calendar year benefit amount of $1250 to help with deductible, co-pay or co-insurance.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Right.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Deductible copay.
[CUSTOMER][NEUTRAL] Marco Insurance, OK, so inpatient.
[CUSTOMER][POSITIVE] Benefit amount.
[CUSTOMER][POSITIVE] An outpatient benefit.
[CUSTOMER][NEUTRAL] I'm not
[CUSTOMER][NEUTRAL] Oh
[CUSTOMER][NEUTRAL] I
[CUSTOMER][NEUTRAL] Deductible copay and co-insurance.
[CUSTOMER][NEUTRAL] And this is what was the last part you said that it kicks in after what?
[AGENT][NEUTRAL] Yes.
[AGENT][NEUTRAL] The primary is billed first and we're built secondary.
[CUSTOMER][NEUTRAL] H
[CUSTOMER][NEUTRAL] Secondary, OK, so you have to wait and see what the primary bills first.
[AGENT][POSITIVE] Correct.
[CUSTOMER][NEUTRAL] OK
[CUSTOMER][NEUTRAL] OK, thank you. Can I have a reference number for the call?
[AGENT][NEUTRAL] Yes ma'am, you can use my name it's [PII] and today's date.
[CUSTOMER][NEUTRAL] 326.
[CUSTOMER][NEUTRAL] I'm [PII].
[CUSTOMER][NEUTRAL] OK, and this goes for whatever services uh she has done just in general, correct?
[AGENT][NEUTRAL] Uh, for outpatient, um.
[CUSTOMER][NEUTRAL] It would be done in the doctor's office.
[AGENT][NEUTRAL] Services
[CUSTOMER][NEUTRAL] Yeah
[AGENT][NEUTRAL] Oh OK, let me check on that for you.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] So, yeah.
[AGENT][NEUTRAL] Let's see if she has physician office visits on her policy.
[CUSTOMER][NEUTRAL] they'll bill for the procedure, but the procedures are done in office.
[AGENT][NEUTRAL] OK, let's see.
[CUSTOMER][NEUTRAL] Yeah
[AGENT][NEUTRAL] I'm gonna need to pull up her complete policy and read it real quick and see if the office visits are covered or not.
[CUSTOMER][NEUTRAL] Uh.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK, so that they have.
[CUSTOMER][NEUTRAL] That they
[CUSTOMER][NEUTRAL] So say safe.
[CUSTOMER][NEUTRAL] Uh.
[CUSTOMER][NEUTRAL] OK, see that that for me.
[AGENT][NEUTRAL] OK. So a covered outpatient facility would be a free standing outpatient surgery center, hospital emergency room, hospital outpatient facility, MRI facility, physical therapy, or urgent care.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] It does not cover office visits.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEGATIVE] Does not cover.
[CUSTOMER][NEUTRAL] In office.
[CUSTOMER][NEUTRAL] Is it
[CUSTOMER][NEUTRAL] OK, so she would have to have it done like in a hospital or an urgent care or some free standing facility for it to cover that.
[CUSTOMER][POSITIVE] Correct.
[AGENT][NEUTRAL] Right. ER urgent care, MRI imaging center, or an ambulatory center.
[CUSTOMER][NEUTRAL] OK
[CUSTOMER][NEUTRAL] that.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][POSITIVE] All right thank you.
[AGENT][POSITIVE] You're very welcome. I hope you have a good rest of your day. We appreciate you calling, Miss [PII]. You, you have a good day. Thanks for calling APL.
[CUSTOMER][NEUTRAL] You too.
[CUSTOMER][POSITIVE] You're welcome bye bye.
[AGENT][NEUTRAL] Bye-bye, ma'am.