AccountId: 011433970860
ContactId: 53580c4c-49f3-44fd-b4d8-0e69462886c6
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 213619 ms
Total Talk Time (AGENT): 119532 ms
Total Talk Time (CUSTOMER): 83246 ms
Interruptions: 0
Overall Sentiment: AGENT=2.1, CUSTOMER=0.8
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/05/06/53580c4c-49f3-44fd-b4d8-0e69462886c6_20250506T16:36_UTC.wav
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[AGENT][POSITIVE] Good morning. Thank you for calling APL. This is [PII]. How may I help you today?
[CUSTOMER][NEUTRAL] Hi [PII], my name is [PII]. I'm calling to try to verify benefits for a patient.
[AGENT][POSITIVE] All right, [PII], I'll be glad to help you. Go ahead and give me your policy number, please, ma'am.
[CUSTOMER][NEUTRAL] OK, is it the group number, the 18635? I just have his card.
[AGENT][NEUTRAL] No, ma'am, I need that certificate number, please, ma'am.
[CUSTOMER][NEUTRAL] Oh OK, OK, the outpatient benefit certificate number 0022.
[AGENT][NEUTRAL] Yes.
[CUSTOMER][NEUTRAL] 95847 M like Mary.
[CUSTOMER][NEUTRAL] L like light bulb 8.
[AGENT][POSITIVE] Alrighty, thank you so much for that, [PII]. Now, while I'm pulling this up, go ahead and give me a good return telephone call number, please, ma'am.
[CUSTOMER][NEUTRAL] Mhm
[CUSTOMER][NEUTRAL] We got [PII].
[AGENT][POSITIVE] Alrighty, [PII], thank you so much for all that information. Now, your patient's name and date of birth.
[CUSTOMER][NEUTRAL] Uh, name is [PII].
[CUSTOMER][NEUTRAL] And uh date of birth is [PII].
[AGENT][NEUTRAL] Alrighty, [PII], thank you so much for all that information. Looks like [PII] is the insured on this medical supplemental plan. I do show his original effective date is [PII]. Patient 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 were checking some type of benefit. Is that correct?
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Yes ma'am.
[AGENT][POSITIVE] Yes, ma'am. What type of benefit are you needing today, [PII]?
[CUSTOMER][NEUTRAL] For um outpatient surgery, any deductible or out of pocket coverage?
[AGENT][NEUTRAL] Alright, let's see. Alright, now, of course, what we are, [PII] is his medical supplemental plan, so the only thing that we would pick up and pay on is anything for sickness and injury that is applied towards his deductible, co-pay or co-insurance at his primary insurance carrier. Now his outpatient benefit here is gonna be a zero deductible, no pre-cert, and he has a $3500 benefit payable per calendar year.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Yes.
[CUSTOMER][NEUTRAL] OK, and he has benefits available for that?
[AGENT][NEUTRAL] Let's see what he's used.
[AGENT][NEGATIVE] As of today, he's not used any of that benefit.
[CUSTOMER][NEUTRAL] OK perfect so um my next question would he have to uh open a claim with you guys or can we just bill you directly?
[AGENT][NEUTRAL] Well, we're just a supplemental, so we'll need that primary AOB from his primary insurance company along with that bill after they process it.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] Yes, ma'am.
[CUSTOMER][NEUTRAL] Per after OK perfect and then could I please have a reference number?
[AGENT][NEUTRAL] Mhm. Yes, ma'am.
[AGENT][NEUTRAL] Well, is that all that I can help answer for you today, [PII]?
[CUSTOMER][POSITIVE] That is you've been most helpful.
[AGENT][NEUTRAL] All right. Well, yes, ma'am, but we don't give reference number, [PII], but you can use my name in today's date and my name is [PII], spelled [PII]
[CUSTOMER][NEUTRAL] OK
[CUSTOMER][POSITIVE] Perfect. You have been an absolute joy thank you so much.
[AGENT][POSITIVE] Well, yes, ma'am, [PII], and thanks for calling APO. You have a great rest of your day, OK?
[CUSTOMER][POSITIVE] You too thanks bye.
[AGENT][POSITIVE] Thank you, ma'am. Bye-bye.