AccountId: 011433970860
ContactId: 5a3f6e37-9809-4294-8425-d6fb1d58be3a
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 335200 ms
Total Talk Time (AGENT): 136981 ms
Total Talk Time (CUSTOMER): 123943 ms
Interruptions: 1
Overall Sentiment: AGENT=1, CUSTOMER=0.9
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/03/11/5a3f6e37-9809-4294-8425-d6fb1d58be3a_20250311T20:30_UTC.wav
--------------------------------------------
[AGENT][POSITIVE] Good afternoon. Thank you for calling APL. My name is [PII]. How may I help you?
[CUSTOMER][NEUTRAL] Mm.
[CUSTOMER][NEUTRAL] Hi, [PII], this is [PII] and I'm calling to get some eligibility and benefits, please.
[AGENT][POSITIVE] OK, I'll be more than happy to assist you with the eligibility and benefits. Did you say your name was [PII]?
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] [PII]. And [PII], may I have a good contact number in case we're disconnected and the policy number?
[CUSTOMER][NEUTRAL] Yeah, [PII]. And yeah, but the policy number, it's just that I'm not sure if the patient provided the right information because I only have 60801.
[AGENT][NEUTRAL] No, that's our payer ID. Do you have the member's full social?
[CUSTOMER][NEUTRAL] No, and I don't have that either, but yeah, I just wanted to confirm that.
[CUSTOMER][NEUTRAL] OK, and it's not possible to search the information by the name and date of birth, right?
[AGENT][NEUTRAL] Yes, I can start you with the first and last name.
[CUSTOMER][NEUTRAL] Um, it is [PII].
[AGENT][NEUTRAL] Can you spell the last name for me, please?
[CUSTOMER][NEUTRAL] [PII]
[AGENT][NEUTRAL] OK, hold on one moment.
[CUSTOMER][NEUTRAL] Mhm
[AGENT][NEUTRAL] And the first name, does it have one S or two?
[CUSTOMER][NEUTRAL] Um, one.
[AGENT][NEUTRAL] Oh, OK.
[CUSTOMER][NEUTRAL] [PII], yeah.
[AGENT][NEUTRAL] Hold on one moment.
[AGENT][NEUTRAL] And can you verify his date of birth?
[CUSTOMER][NEUTRAL] Sure. Um, [PII].
[AGENT][NEUTRAL] Thank you and all the information provided is a verification of benefits, not a guarantee of payment. So I am showing the policy is active. It's been effective since [PII].
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] The policy number is 249.
[AGENT][NEUTRAL] 7672.
[CUSTOMER][POSITIVE] Got it thank you.
[AGENT][POSITIVE] You're welcome.
[CUSTOMER][NEUTRAL] OK. So, yeah. Well, um, I was calling to get the benefits. I don't know, guys, how you work like um with deductible and out of pocket. I don't know if you have like individual amounts for that.
[AGENT][NEUTRAL] So this is the member's secondary policy, so we pay towards the copay, deductible and co-insurance after primary um of covered charges. So if you considered well for outpatient and inpatient, um, the calendar year max each is $7900.
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] Are you considered outpatient?
[CUSTOMER][NEUTRAL] Um, yes, we are.
[AGENT][NEUTRAL] OK, did you want me to see if he's used any of the benefits for this year?
[CUSTOMER][NEUTRAL] Um, yeah, please. Well, I have CVD codes or the one, the name of the procedures.
[AGENT][NEUTRAL] Um, it doesn't go by procedure or what's being done. It goes by place of service, outpatient or inpatient, but
[CUSTOMER][NEUTRAL] Oh, yeah. It's outpatient with the specialist.
[AGENT][NEUTRAL] So he hasn't used any of the benefits for [PII], so he still has that full $7900.
[AGENT][NEUTRAL] If this is considered in office, um, the policy does have the office treatment right in which the treatment, um, could be covered up to that $7900 as long as it's not cosmetic.
[CUSTOMER][NEUTRAL] OK. Perfect. Thank you. So that will be basically for all services. And you said that there is no either like deductible or out of pocket amounts and um I guess that referrals are not required.
[AGENT][NEUTRAL] Correct, um, referrals and pre-authorization is not required.
[CUSTOMER][NEUTRAL] Thank you. Um, may I know what type of plan is this?
[AGENT][POSITIVE] You're welcome.
[AGENT][NEUTRAL] This is the Medlink supplemental gap insurance policy.
[CUSTOMER][POSITIVE] Perfect. Thank you. And is there any group number?
[AGENT][NEUTRAL] Um, yes, hold on one moment.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] The group number is 15493.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][POSITIVE] Got it. Perfect. Thank you. So, um, just to confirm, um, it, well, this plan will cover up to $7900 which the patient has met $0 so far, right?
[AGENT][POSITIVE] Right. Mhm, that's correct.
[CUSTOMER][NEUTRAL] Thank you. And yup, last thing is, can I get the claim address?
[AGENT][NEUTRAL] Sure, it's PO Box 248.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] 950.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] Oklahoma City.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] Oklahoma.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] The zip code is [PII].
[CUSTOMER][NEUTRAL] Hm
[CUSTOMER][POSITIVE] Perfect. Thank you. And yeah, can I get a call reference number? Thank you.
[AGENT][NEUTRAL] You're welcome. So there's no call reference number, but you can use my name in today's date. First initial to my last name is [PII].
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][POSITIVE] Got it. Perfect. Thank you again. Have a good one.
[AGENT][POSITIVE] You're welcome and thanks for calling APL. I hope you have a great day. Bye-bye.
[CUSTOMER][POSITIVE] Thanks.
[CUSTOMER][NEUTRAL] Bye-bye.