AccountId: 011433970860
ContactId: 5774adaa-8cd4-4c57-a862-96b56e06db6d
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 290609 ms
Total Talk Time (AGENT): 109923 ms
Total Talk Time (CUSTOMER): 72763 ms
Interruptions: 0
Overall Sentiment: AGENT=0.6, CUSTOMER=0.2
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/06/12/5774adaa-8cd4-4c57-a862-96b56e06db6d_20250612T21:36_UTC.wav
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[AGENT][NEUTRAL] Thank you for calling APL. This is [PII]. How can I help you?
[CUSTOMER][NEUTRAL] Hi, yes, [PII]. I'm calling to inquire about benefits for a patient having an upcoming surgery with us.
[AGENT][POSITIVE] Yeah, I can help you with benefits. Um, who am I speaking with?
[CUSTOMER][NEUTRAL] This is [PII] with Madison Physician Surgery Center.
[AGENT][NEUTRAL] You said medicine physician?
[CUSTOMER][NEUTRAL] Yes, physician Surgery Center.
[AGENT][NEUTRAL] OK, and what's a good callback number in case we get disconnected?
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] And the policy number?
[CUSTOMER][NEUTRAL] It is [PII].
[AGENT][NEUTRAL] OK, [PII].
[CUSTOMER][NEUTRAL] 125.
[AGENT][NEUTRAL] 125 OK give me just one moment to look that up.
[CUSTOMER][NEUTRAL] Oh
[AGENT][NEUTRAL] And can I get the patient's name and date of birth, please?
[CUSTOMER][NEUTRAL] [PII]. Date of birth is [PII].
[AGENT][POSITIVE] Alright, thank you so much.
[AGENT][NEUTRAL] Alright, and you were wanting outpatient benefits correct?
[CUSTOMER][NEUTRAL] Yes.
[AGENT][NEUTRAL] Alright, let me pull up their policy.
[CUSTOMER][NEUTRAL] Uh
[AGENT][NEUTRAL] And I am showing that this is their secondary gap insurance policy, so they, you will need uh
[CUSTOMER][NEUTRAL] Uh
[AGENT][NEUTRAL] To file the primary EOB um whenever filing a claim for this one.
[AGENT][NEUTRAL] And let me see what they have.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] Right, and this is just a verification of benefits, not a guarantee of payment. I show that they have an outpatient benefit maximum of up to $5000 per calendar year.
[AGENT][NEUTRAL] With a $0.00 I'm sorry, with a $100 outpatient deductible per calendar year.
[AGENT][NEUTRAL] And let me see. Uh, it looks like they do have surgery in a hospital, outpatient facility or freestanding outpatient surgery center with a maximum of 30 days of treatment per calendar year.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK, so then basically all he really owes is just gonna be that $100 deductible.
[AGENT][NEUTRAL] Um, yes, it looks like there's just a $100 deductible, uh, for the calendar year. Hm.
[CUSTOMER][NEUTRAL] OK, has
[CUSTOMER][NEUTRAL] OK. Has anything been accumulated?
[AGENT][NEUTRAL] Uh, let me look.
[AGENT][NEUTRAL] It looks like he has not used any of his benefits for the calendar year.
[CUSTOMER][NEUTRAL] OK, and he doesn't have any co-insurance. It's just that deductible with $5000 max.
[AGENT][NEUTRAL] Yes, this is this is secondary insurance, so it does help cover the cost of co-pay, co-insurance and co-deductible, but um, yeah, as far as I know this is just a secondary gap.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] OK
[CUSTOMER][NEUTRAL] OK, all right, I just needed to get that confirmed. Uh, we had someone call earlier and she was a little bit confused, um, with it only being $100 because we're normally used to like a higher amount, um, so I just wanted to call and double check. Can I get a reference number?
[AGENT][NEUTRAL] Mhm.
[AGENT][NEUTRAL] Mhm.
[AGENT][NEUTRAL] So we don't have reference numbers, but you can use my first name and last initial in today's date. So [PII] and [PII]'s date.
[CUSTOMER][POSITIVE] All right well thank you so much Miss [PII].
[AGENT][POSITIVE] Thank you so much for calling APL. I hope you have a great day.
[CUSTOMER][NEUTRAL] You too. Bye-bye.
[AGENT][NEUTRAL] Bye.