AccountId: 011433970860
ContactId: 42073602-a010-40fb-90ec-a4cc1aef0a03
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 339720 ms
Total Talk Time (AGENT): 146703 ms
Total Talk Time (CUSTOMER): 190671 ms
Interruptions: 3
Overall Sentiment: AGENT=0.5, CUSTOMER=0.1
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/01/15/42073602-a010-40fb-90ec-a4cc1aef0a03_20250115T15:22_UTC.wav
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[AGENT][NEUTRAL] Thank you for calling AL. This is [PII]. How can I help you?
[CUSTOMER][NEUTRAL] Students, this is just an estimate.
[CUSTOMER][NEUTRAL] Yes, hi. I have a patient here. Uh,
[CUSTOMER][NEUTRAL] We're just trying to verify.
[CUSTOMER][NEUTRAL] Uh, she's active.
[AGENT][NEUTRAL] Just wanted to verify eligibility.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] OK, yeah, I can check that for you uh what was your name?
[CUSTOMER][NEUTRAL] Um, uh, [PII], coming from Baptist diagnostics in here.
[AGENT][NEUTRAL] OK.
[AGENT][POSITIVE] OK [PII], can I get a good call back number from you in case we're disconnected?
[CUSTOMER][NEUTRAL] Uh, number is [PII].
[AGENT][NEUTRAL] OK, thank you and then do you have the policy number?
[CUSTOMER][NEUTRAL] Yes.
[CUSTOMER][NEUTRAL] Uh,
[CUSTOMER][NEUTRAL] And here says 19719.
[CUSTOMER][NEUTRAL] Yeah
[CUSTOMER][NEUTRAL] I.
[AGENT][NEUTRAL] I'm sorry, could you repeat that policy number, [PII]?
[CUSTOMER][NEUTRAL] 19719.
[AGENT][NEUTRAL] OK, that's gonna be a bit too short to be one of our policy numbers. uh, let's see.
[AGENT][NEUTRAL] You maybe have their social I could search them for them that way.
[CUSTOMER][NEUTRAL] Uh,
[CUSTOMER][NEUTRAL] I don't know. I'm just calling from here. I don't have, uh, let me, uh, it will be better if the.
[CUSTOMER][NEUTRAL] Patient will call because I don't have the social and I don't have any information of that.
[AGENT][NEUTRAL] Um, do you have
[CUSTOMER][NEUTRAL] They say here, OK, this is the number. They say a patient benefit cert number, that's the one you want? OK, it's [PII]
[AGENT][NEUTRAL] I'm sorry, go ahead.
[AGENT][NEUTRAL] Yes, please.
[CUSTOMER][NEUTRAL] 8
[AGENT][NEUTRAL] OK, that sounds more like one of ours, yes ma'am alright uh what was the name and date of birth for the insured?
[CUSTOMER][NEUTRAL] Is that sounds better?
[CUSTOMER][NEUTRAL] Mhm
[CUSTOMER][NEUTRAL] Uh, [PII].
[CUSTOMER][NEUTRAL] And date of birth is [PII].
[AGENT][NEUTRAL] OK, thank you for verifying that [PII]. Uh, so this policy number you gave me actually terminated [PII]. If you'll give me one moment, I'll see if she has one that's active. It might just be a different policy number.
[CUSTOMER][NEUTRAL] Mhm
[CUSTOMER][NEUTRAL] Yeah. She said that was terminated [PII].
[CUSTOMER][NEUTRAL] I'm gonna.
[AGENT][NEUTRAL] OK, I did find one that is currently active. It's a different policy number let me know when you're ready.
[CUSTOMER][NEUTRAL] Uh, OK, you have the policy number or we have it?
[AGENT][NEUTRAL] The policy number you gave me was an older one that terminated in [PII], yeah, so she does have a newer one, and I've got that whenever you're ready.
[CUSTOMER][NEUTRAL] Yeah, I know.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK, which one it is?
[AGENT][NEUTRAL] OK, so the one that is active is 021-97548.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] OK, and this policy's effective date was [PII].
[CUSTOMER][NEUTRAL] I.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] It's active then. Another thing, um, what I was trying to check because she have a primary uh insurance with Cigna HMO and uh today she came to do a bone density mammogram and ultrasound and her uh
[AGENT][NEUTRAL] Mhm
[AGENT][NEUTRAL] Yes.
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] And her uh total today is 1508.
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Dollars 52 cents. How much will you cover from your end?
[AGENT][NEUTRAL] Is that after uh Cigna paid?
[CUSTOMER][NEUTRAL] Yeah, and here what they put is in the comments. I just registered the patients I just read to you what they say here that um verification reference, insurance, insurance adjust adjust the charges is $1500 or 8 and the subtract individual deductible remaining is $5000.
[AGENT][NEUTRAL] Mhm.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] Oh I see OK.
[CUSTOMER][NEUTRAL] And, and she has a 20% co-insurance percentage, and it's for that, she said that she never paid that much, it's for that we call to this.
[AGENT][NEUTRAL] Mhm. OK.
[AGENT][NEUTRAL] Sure, OK, so as this is a secondary medical it is designed to help with co-pay, deductible and co-insurance, um, so give me just a moment, of course I will let you know [PII], verification of coverage is not a guarantee of payment for claims, so her outpatient benefit is $2000 max per calendar year and I know the year just started, but let me see if any of that has been used. Give me just a moment.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Is a
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Of course you know give it to 10.
[AGENT][NEUTRAL] OK, so none of that has been used. She does have that full $2000 for her outpatient benefit.
[CUSTOMER][NEUTRAL] OK, would it have to be 0 then?
[CUSTOMER][NEUTRAL] She will have not
[AGENT][NEUTRAL] I'm sorry?
[CUSTOMER][NEUTRAL] She wouldn't have to pay anything today then?
[AGENT][NEUTRAL] Um, I couldn't say exactly until we received the claim. That's just how much her total outpatient benefit is.
[CUSTOMER][NEUTRAL] OK, I will put it. What is the reference number?
[AGENT][NEUTRAL] Yeah, reference number would just be my first name, last initial, and today's date. Uh so my name is spelled [PII] last initial is [PII] Was there anything else I could help you with, [PII]?
[CUSTOMER][NEUTRAL] A a oh there is no number or reference number or anything? OK.
[AGENT][NEUTRAL] Right.
[AGENT][NEUTRAL] Um, it's my 1st, 1st name, last initial and today's date.
[CUSTOMER][POSITIVE] OK, OK dokey, and that's it. OK, thank you so much. OK.
[AGENT][POSITIVE] Alright, yeah, thanks for calling APL. I hope you have a great rest of your day.
[CUSTOMER][NEUTRAL] Bye bye, bye bye.
[AGENT][POSITIVE] Thank you bye bye.