AccountId: 011433970860
ContactId: 53273ef7-853a-45fa-9be5-3e46bcd67d91
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 223210 ms
Total Talk Time (AGENT): 142574 ms
Total Talk Time (CUSTOMER): 65076 ms
Interruptions: 0
Overall Sentiment: AGENT=1, CUSTOMER=0.8
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/02/26/53273ef7-853a-45fa-9be5-3e46bcd67d91_20250226T16:05_UTC.wav
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[AGENT][NEUTRAL] And thank you for calling APL. This is [PII]. How may I help you today?
[CUSTOMER][NEUTRAL] Hi, I'm calling to um see if a patient has bariatric surgery coverage and get some eligibility information as well.
[AGENT][NEUTRAL] OK.
[AGENT][POSITIVE] Alright, I'll be glad to help you go ahead and give me uh your name and the member's policy number please.
[CUSTOMER][NEUTRAL] [PII] Z S U Z I E policy number 1993479.
[AGENT][POSITIVE] Alrighty, thank you for that, [PII]. Now while I'm pulling this up, go ahead and give me a good return telephone call number.
[CUSTOMER][NEUTRAL] Direct line [PII].
[AGENT][NEUTRAL] Alright, thank you for all that information. [PII]. Now, what's your patient's name and date of birth?
[CUSTOMER][NEUTRAL] [PII] [PII]
[AGENT][NEUTRAL] Alrighty, thank you for that, [PII]. It looks like [PII] is the insured on this medical supplemental plan to show her original effective date is [PII]. She is current and active, but I must advise that verification of coverage is not a guarantee of payment on a claim, but you did say you're checking benefits. Is that correct?
[CUSTOMER][NEUTRAL] Yes.
[AGENT][NEUTRAL] All right, let me go on there. OK, now, of course, what we are is just her medical supplemental plan, uh, to her primary major medical coverage. Uh, the only thing that we would pick up and pay on is for sickness or injury that is medically necessary and that is applied towards her deductible co-pay or co-insurance at her primary insurance company. Nothing routine here is covered no matter what.
[CUSTOMER][NEUTRAL] in there.
[AGENT][NEUTRAL] Now outpatient benefit here is gonna be zero deductible, no pre-cert, and a $3500 benefit available for outpatient benefits per calendar year.
[CUSTOMER][NEUTRAL] Right
[CUSTOMER][NEUTRAL] OK, um, after you, um, said about her medical supplemental plan, um, there was some disruption in the office. I apologize. I didn't hear what all you said.
[AGENT][NEUTRAL] OK, well we are it's just her medical supplemental plan, so, uh, that is to her primary major medical coverage. The only thing that we would pick up and pay on here is if it is applied towards her deductible, co-pay, or co-insurance for sickness and injury only at her primary insurance carrier. Nothing routine here is covered no matter what.
[CUSTOMER][NEUTRAL] OK. Nothing routine and no um no surgery would be covered?
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] Nothing retain covered, no, ma'am.
[CUSTOMER][NEUTRAL] OK. Um, what about surgical?
[AGENT][NEUTRAL] Mm
[AGENT][POSITIVE] Yes ma'am, she has an outpatient benefit.
[CUSTOMER][NEUTRAL] Uh, what about inpatient?
[AGENT][NEUTRAL] Inpatient, let's see, inpatient would be zero deductible, no pre-cert here, and she has a $3500 benefit payable for inpatient.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Um, what if the primary insurance will, has an exclusion for this?
[AGENT][NEGATIVE] It's not covered here at all.
[CUSTOMER][NEUTRAL] Not covered, OK, alright, and what was your name again?
[AGENT][NEUTRAL] No, ma'am.
[AGENT][NEUTRAL] My name is [PII]. That's [PII] And is that all that I can help you with today, [PII]?
[CUSTOMER][POSITIVE] Yes ma'am, can I get a call reference please?
[AGENT][NEUTRAL] All right. We do not give call reference number, [PII], but you can use my name in today's date if you need to do so, OK?
[CUSTOMER][POSITIVE] Thank you so much. Have a good one.
[AGENT][POSITIVE] Yes, ma'am. You as well, [PII], and thanks for calling APL. Bye-bye.
[CUSTOMER][NEUTRAL] Bye.