AccountId: 011433970860
ContactId: 4a152de9-1451-45e2-a793-f629282a84de
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 208270 ms
Total Talk Time (AGENT): 96021 ms
Total Talk Time (CUSTOMER): 79089 ms
Interruptions: 0
Overall Sentiment: AGENT=0.4, CUSTOMER=1.4
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/01/22/4a152de9-1451-45e2-a793-f629282a84de_20250122T13:16_UTC.wav
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[AGENT][NEUTRAL] Thank you for calling APL. This is [PII]. How can I help you?
[CUSTOMER][NEUTRAL] Um, hi, [PII]. This is [PII]. I'm calling from the provider's office checking for eligibility and benefits, and how are you doing today?
[AGENT][POSITIVE] I'm good. How are you, [PII]?
[CUSTOMER][POSITIVE] Yes, I'm doing good as well thank you so much for asking.
[AGENT][NEUTRAL] OK, that's good. Um, could I get a good callback number just in case we're disconnected?
[CUSTOMER][NEUTRAL] Oh, sure. My callback number is [PII] and it's a direct line.
[AGENT][NEUTRAL] Thank you. Now, I need the policy number, please.
[CUSTOMER][NEUTRAL] Um, sure. The member ID is 02297912.
[AGENT][NEUTRAL] Please verify the patient's name and date of birth.
[CUSTOMER][NEUTRAL] Um, sure. The patient's name is [PII] and her date of birth is [PII].
[AGENT][NEUTRAL] Thank you and just let me advise you that verification of coverage does not guarantee payment of claims. Um, the effective date on this policy was [PII]. The policy is still active. Um, is this for inpatient or outpatient benefits or an office visit?
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Uh, yes, uh, the outpatient benefit, uh, uh, the patient is coming for.
[CUSTOMER][NEUTRAL] Uh hospital ambulatory surgical.
[AGENT][NEUTRAL] OK. Yes, ma'am. That's covered under the outpatient benefit and for outpatient, we cover up to 1000 per calendar year and that's for the co-pay, the co-insurance, and the deductible after the primary insurance processes the claim.
[CUSTOMER][NEUTRAL] Uh
[CUSTOMER][NEUTRAL] Oh, OK, so is it a kind of a an indemnity plan like a limited benefits plan, am I correct?
[AGENT][NEUTRAL] Um, it's Secondary Gap Insurance.
[CUSTOMER][NEUTRAL] A secondary gap. All right.
[CUSTOMER][NEUTRAL] And
[CUSTOMER][POSITIVE] All right, thank you so much for that. So there won't be any uh patient responsibility like the out of pocket or deductible?
[AGENT][NEUTRAL] Right, because we covered that portion. We covered that portion up to 1000 per calendar year.
[CUSTOMER][NEUTRAL] Uh, I get that. Thank you for that information, Ay, and may I also have the group name and group number please?
[AGENT][NEUTRAL] Um, yes, one moment.
[CUSTOMER][NEUTRAL] Sure.
[AGENT][NEUTRAL] OK, the group name is Questco. Um, it's Q like Queen, U like umbrella, E like Edward, S like Sam, T like Tom, C like cat, O like Oscar. That's the name of the group Questco, and the group number is 19874.
[CUSTOMER][NEUTRAL] Mm.
[CUSTOMER][POSITIVE] All right. Thank you so much for that, [PII]. And yeah, can I have the call reference for today's call, please?
[AGENT][NEUTRAL] Um, yes, for the reference number, you can use my name and today's date. Um, my name is spelled [PII], and today's date. Is there anything else that I can assist you with?
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][POSITIVE] Uh, that's all for today, [PII], and thank you for all the assistance you provided me and you have a great day. Bye bye.
[AGENT][NEUTRAL] You do the same, [PII]. Thank you for calling APL. Mm bye.
[CUSTOMER][POSITIVE] Uh thank you, bye bye.