AccountId: 011433970860
ContactId: 4c77b67c-04f2-4780-aa6b-49d6c4e5dbf6
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 277429 ms
Total Talk Time (AGENT): 111740 ms
Total Talk Time (CUSTOMER): 138170 ms
Interruptions: 1
Overall Sentiment: AGENT=0.5, CUSTOMER=0.6
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/02/12/4c77b67c-04f2-4780-aa6b-49d6c4e5dbf6_20250212T18:16_UTC.wav
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[AGENT][POSITIVE] Thanks for calling APL. This is [PII]. How may I help you?
[CUSTOMER][NEUTRAL] Uh, hi, [PII]. My name is [PII]. Um, I'm calling from the Specialty surgical Center of North Brunswick. Um, I'm a patient and, um, I just have some questions about his coverage, if you'd be able to help me.
[AGENT][NEUTRAL] OK, I can I can help you. What's your name?
[CUSTOMER][NEUTRAL] Uh, the patient's name is [PII]. Oh, my name is [PII] Mhm.
[AGENT][NEUTRAL] Your name?
[AGENT][NEUTRAL] Let me get your name. Yes, [PII], OK. I know you said it, but I missed it.
[AGENT][NEUTRAL] And what's the policy number?
[CUSTOMER][NEUTRAL] That's OK.
[CUSTOMER][NEUTRAL] Um, policy number he gave me is 021-777-41 M as in Mary, L as in Larry, and the number 8.
[AGENT][NEUTRAL] And what's a good phone number in case we're disconnected?
[CUSTOMER][NEUTRAL] [PII]
[AGENT][POSITIVE] OK, thank you.
[AGENT][NEUTRAL] And the patient's name and date of birth?
[CUSTOMER][NEUTRAL] [PII]. Date of birth is [PII].
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] OK, so now this is not the most current policy number. Would you like to write the current policy number down?
[CUSTOMER][NEUTRAL] They have a list of idea.
[CUSTOMER][NEUTRAL] Yes, please.
[AGENT][NEUTRAL] OK, so the number is 235.
[AGENT][NEUTRAL] 637 8.
[AGENT][NEUTRAL] And this policy became effective [PII] currently active at this time.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] And you said that you wanted to talk about the benefits?
[CUSTOMER][NEUTRAL] Um, so this is.
[CUSTOMER][NEUTRAL] Yeah, because I know he has a primary insurance, which is United Healthcare, and this patient is coming in on [PII] to have an endoscopy.
[AGENT][NEUTRAL] Mhm.
[AGENT][NEUTRAL] Uh-huh.
[CUSTOMER][NEUTRAL] And his primary benefit, um, it will cover it at 100% after he meets his deductible, and his deductible is $1500 which he hasn't met any of that yet. So I didn't know it would you, would you guys cover any of that deductible, being that you're the secondary insurance or um because I didn't know if this was just hospitalization or how, how does this work, because I've never heard of American public life, so I just wanted to see.
[AGENT][NEUTRAL] Mhm.
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] What the benefit would be um as a secondary.
[AGENT][NEUTRAL] OK, so the policy with APL is a Metlink policy. It's like a gap policy.
[AGENT][NEUTRAL] And the um maximum outpatient sounds like it's gonna be an outpatient procedure, the maximum.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Yes, it's
[CUSTOMER][NEUTRAL] It's um an outpatient procedure at the ambulatory surgical center.
[AGENT][NEUTRAL] OK, and so the maximum outpatient benefit under this policy is up to $750 per calendar year. So whatever amount the primary insurance applies towards the calendar year deductible or co-insurance amount or co-pay amount, this policy will reimburse covered charges up to $750 per calendar year.
[CUSTOMER][NEUTRAL] OK, but you're, you're only gonna reimburse if it's a co-pay or co-insurance, not deductible?
[AGENT][NEUTRAL] Yeah, I included deductible, deductible co-insurance and or and or co-payment.
[CUSTOMER][NEUTRAL] Oh
[CUSTOMER][NEUTRAL] Oh, OK, OK, so, so out of the 1500, you'll pay up to 750 and then he would be responsible for what's left of that?
[AGENT][NEUTRAL] Mhm.
[AGENT][NEUTRAL] OK, so we don't determine patients responsibility, but we will cover up to his benefit maximum which is 750, and I don't show any of that has been used this year.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] OK, Benefit max. OK, alright, thank you, [PII]. And if I could just get a um a reference number for the call and do do actually one more question, do you guys require any type of authorization or anything?
[AGENT][NEUTRAL] Mhm.
[AGENT][NEUTRAL] Yeah, prior authorization is not required.
[CUSTOMER][NEUTRAL] Not required, OK.
[AGENT][NEUTRAL] Mhm. And then you will use my name and today's date as reference for today's call. It's [PII].
[CUSTOMER][NEUTRAL] OK, and then you said today's date as well.
[AGENT][NEUTRAL] Uh-huh.
[CUSTOMER][POSITIVE] OK, great. Thank you, [PII]. I appreciate your help.
[AGENT][POSITIVE] Thank you for calling ET Health. Have a good day, [PII].
[CUSTOMER][POSITIVE] You too thank you bye bye.