AccountId: 011433970860
ContactId: 48913014-93c9-49b9-ae43-50f23f5f5c97
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 189869 ms
Total Talk Time (AGENT): 107987 ms
Total Talk Time (CUSTOMER): 47186 ms
Interruptions: 0
Overall Sentiment: AGENT=1.3, CUSTOMER=0.3
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/04/29/48913014-93c9-49b9-ae43-50f23f5f5c97_20250429T13:41_UTC.wav
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[AGENT][POSITIVE] Thanks for calling APL, this is [PII]. How may I assist you?
[CUSTOMER][NEUTRAL] Good morning. I'm calling to verify the benefits for this patient's gap insurance.
[AGENT][POSITIVE] Sure, I can assist you with that. Can I have your name and a callback number?
[CUSTOMER][NEUTRAL] Sure, [PII] [PII].
[AGENT][NEUTRAL] And what is the policy number?
[CUSTOMER][NEUTRAL] It is 02509834.
[AGENT][NEUTRAL] Can you verify that patient's name and date of birth, [PII]? You did say your name was [PII], correct?
[CUSTOMER][NEUTRAL] Yes, correct, [PII] [PII].
[AGENT][POSITIVE] Thank you.
[AGENT][NEUTRAL] This policy has been active since [PII]. [PII] and it's currently active.
[AGENT][NEUTRAL] [PII] has
[CUSTOMER][NEUTRAL] OK, and mhm.
[AGENT][NEUTRAL] Go ahead. What were you about to ask me?
[CUSTOMER][NEUTRAL] No, go ahead.
[AGENT][NEUTRAL] [PII] has outpatient benefits of $8700 per calendar year.
[AGENT][NEUTRAL] And this is not a guarantee of benefits, just a disclaimer of the policy's coverage.
[CUSTOMER][NEUTRAL] OK, so and there's no is there a way to know how much would be covered or if the services he's going to be getting today will be covered?
[AGENT][NEUTRAL] What is the place of service?
[CUSTOMER][NEUTRAL] that outpatient radiology.
[AGENT][NEUTRAL] Got you, so this policy is a gap insurance. I, I don't, I'm not sure how much the bill will be, so I can't give you that amount. I can only give you his yearly maximum benefit amount that I just provided you with.
[AGENT][NEUTRAL] And once you submit a claim because this is a gap insurance that assists with the deductible co-pay and co-insurance to the primary because I'm not sure if you may, you guys may charge.
[AGENT][NEUTRAL] Bill him for $3500 but yeah you may be in network with his primary insurance company so that means that they're not gonna charge the full $3500 they're gonna do a allowed amount which is the allowed amount that's gonna go towards the member's deductible copay and co-insurance if he still have out of pocket balance on his account then that claim should be submitted here.
[CUSTOMER][NEUTRAL] Right.
[AGENT][NEUTRAL] So whatever is remaining under the deductible, co-pay or co-insurance, that's what this policy will pay.
[CUSTOMER][NEUTRAL] OK, and he still has that full amount available, the 8700?
[AGENT][NEUTRAL] And this is not a guaranteed benefits just a disclaimer of the policy's coverage, and he has no history on file, so his benefits is still available, the full benefit amount [PII]. Is there anything else that I can assist you with today?
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Just your name and if you provide a reference number.
[AGENT][NEUTRAL] We don't provide reference numbers. However, my name is [PII] and today's date is a reference.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][POSITIVE] Perfect thank you.
[AGENT][POSITIVE] You're welcome. Thanks for calling APL. Have a good day. Goodbye. This is [PII]. Come to the air.
[CUSTOMER][NEUTRAL] You too bye bye.