AccountId: 011433970860
ContactId: 4af7ccd5-6198-4741-881e-62608dcbfadf
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 172339 ms
Total Talk Time (AGENT): 63065 ms
Total Talk Time (CUSTOMER): 76056 ms
Interruptions: 1
Overall Sentiment: AGENT=1.3, CUSTOMER=0.4
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/05/12/4af7ccd5-6198-4741-881e-62608dcbfadf_20250512T17:11_UTC.wav
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[AGENT][POSITIVE] Thank you for calling APL. My name is [PII]. How can I assist you today?
[CUSTOMER][NEUTRAL] Hi [PII], my name is [PII] calling from AdventHealth calling in reference to a mutual patient of ours.
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] And I have uh [PII] with the date of birth is [PII].
[AGENT][POSITIVE] OK, I'll be happy to assist today, [PII] if I can get a good call back number for you.
[CUSTOMER][NEUTRAL] My callback number would be [PII].
[AGENT][NEUTRAL] OK, and what is that policy number?
[CUSTOMER][NEUTRAL] Say that again, ma'am.
[AGENT][NEUTRAL] The policy number?
[CUSTOMER][NEUTRAL] Oh
[CUSTOMER][NEUTRAL] So looking at his card for the outpatient benefit cert number I have 016.
[CUSTOMER][NEUTRAL] 593-36 ML 8
[AGENT][NEUTRAL] And are you calling for um benefits or claim status?
[CUSTOMER][NEUTRAL] For benefits.
[AGENT][NEUTRAL] OK, I'll be happy to assist with benefits. Please be advised of verification of coverage is not a guarantee of payment. I do show the policy is currently active. Effective date is [PII].
[CUSTOMER][NEUTRAL] Uh.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Uh huh OK.
[CUSTOMER][NEUTRAL] OK
[AGENT][NEUTRAL] And are you calling for inpatient or outpatient benefits?
[CUSTOMER][NEUTRAL] Yes, he's coming in for an outpatient surgical benefit. And you said that plan was affected what date?
[AGENT][NEUTRAL] [PII] I do show the outpatient calendar year maximum is $2500.
[CUSTOMER][NEUTRAL] OK, now we have Aetna primary for him, so will this serve for his secondary, correct?
[AGENT][NEUTRAL] That's correct, we're the gap insurance.
[CUSTOMER][NEUTRAL] Secondary.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][POSITIVE] And it is effective now this plan covers just 2500 of the cost.
[AGENT][POSITIVE] That's correct.
[CUSTOMER][NEUTRAL] Play cover.
[AGENT][NEUTRAL] Whatever his patient responsibility is, so if they apply $2500 to his deductible or coinsurance, then um that's what we'll pay if it goes over that. The max we'll pay is $2500 per calendar year for his outpatient.
[CUSTOMER][NEUTRAL] That
[CUSTOMER][NEUTRAL] Max will pay will be $2500 towards patient responsibility.
[CUSTOMER][NEUTRAL] OK. Can I have a reference?
[AGENT][NEUTRAL] I'm sorry?
[CUSTOMER][NEUTRAL] Can I have a reference uh for this call, reference number?
[AGENT][NEUTRAL] Oh reference um for the call is just my name [PII] last initial [PII], and the date and time of the call. Was there anything else I can assist with today?
[CUSTOMER][POSITIVE] Oh no, ma'am. Thank you so much, ma'am.
[AGENT][POSITIVE] Thank you for calling APL. You have a good day.