AccountId: 011433970860
ContactId: 5afd04f3-df9f-4ab6-86a5-293f9f284848
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 246750 ms
Total Talk Time (AGENT): 106732 ms
Total Talk Time (CUSTOMER): 114566 ms
Interruptions: 0
Overall Sentiment: AGENT=2.9, CUSTOMER=1
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/01/14/5afd04f3-df9f-4ab6-86a5-293f9f284848_20250114T17:13_UTC.wav
--------------------------------------------
[AGENT][NEUTRAL] Hi, thank you for calling APL. This is [PII]. How can I help you today?
[CUSTOMER][NEUTRAL] Hi, yes, good afternoon. Uh, my name is [PII], and I was calling to see if you can help me, uh, with, um, eligibility and benefits for a patient.
[AGENT][POSITIVE] Oh, I'd love to do that today, ma'am. Do you mind if I get a good call back number from you real quick?
[CUSTOMER][NEUTRAL] Yes, it is [PII] direct line.
[AGENT][POSITIVE] Perfect and what's the policy number we wanna look at today?
[CUSTOMER][NEUTRAL] OK, the number that I was given from the patient is
[CUSTOMER][NEUTRAL] Where is it at? 02374821, M as in Michael, L as in Larry, 8.
[AGENT][POSITIVE] Thank you, I appreciate that. Give me one moment to get the policy pulled up for you.
[CUSTOMER][POSITIVE] OK, thank you.
[AGENT][POSITIVE] My pleasure.
[AGENT][NEUTRAL] And can you verify your patient's first and last name and date of birth, please?
[CUSTOMER][NEUTRAL] Yes.
[CUSTOMER][NEUTRAL] Um,
[CUSTOMER][NEUTRAL] Where did I?
[CUSTOMER][NEUTRAL] That is uh [PII] or [PII], and the date of birth is [PII].
[AGENT][POSITIVE] Wonderful, thank you so much. Um, your patient is current and active. The effective date is going to be [PII].
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] And then you said you're looking for benefits as well as eligibility. Are you looking for inpatient or outpatient benefits today?
[CUSTOMER][NEUTRAL] Outpatient and I also need to see if you are um.
[AGENT][POSITIVE] Perfect
[CUSTOMER][NEUTRAL] Um, in network with our facility.
[AGENT][NEUTRAL] Perfect. OK. I do wanna let you know any benefit information I give you over the phone is gonna be a verification of coverage, not a guarantee of payment, and your patient does have an outpatient benefit maximum with us of $6600 per calendar year. Um, and then as far as network, we don't have a network but we rather we follow the major medical, um, so if the major medicals in.
[AGENT][NEUTRAL] Network with you guys like we follow them. I don't know if that makes sense.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Yeah, um, so I'm pretty much trying to figure out, um, with this go as his secondary because he has a primary and with a hefty um deductible.
[CUSTOMER][NEUTRAL] And he gave me this information stating that uh this would pretty much probably help cover I guess the deductible so I needed to see if that's how this plan works, if this would go as a secondary.
[AGENT][NEUTRAL] Yeah, we're his secondary to his major medical, and what we do is we try to pick up on pay on things that are applied to the copay, coinsurance and deductible, um, for accident, illness, or sickness. We don't cover anything routine here, um, but we, we are the secondary. So when you file your claim with us, you'll want to include the primary EOB.
[CUSTOMER][NEUTRAL] OK. And what did you say you cover? You said nothing routine, but what was the things you mentioned?
[AGENT][NEUTRAL] Accident, illness, or sorry, accident injury, sickness?
[CUSTOMER][NEUTRAL] Accident, injury, and sickness. OK. So he is, uh, not sure if I can run the codes by you to see if this is something that you do cover.
[AGENT][NEUTRAL] I can't check through the codes, no, we just have to have it come through on the claim form.
[CUSTOMER][NEUTRAL] OK, OK.
[AGENT][NEUTRAL] I'm sorry.
[CUSTOMER][POSITIVE] All right. Oh no, you're fine, you're fine. All right, well thank you so much and I'm sorry, can I get your name one more time please?
[AGENT][NEUTRAL] Oh, yes, it's [PII], first [PII], last name, [PII].
[CUSTOMER][NEUTRAL] Alright, and do you provide reference numbers?
[AGENT][NEUTRAL] Um, we do, but it's not like a number, it's just my name and today's date.
[CUSTOMER][POSITIVE] OK, OK, no problem. Thank you so much for all of your help.
[AGENT][POSITIVE] Yes, it's my pleasure, Ms. [PII]. Thanks for calling APL, and I hope you have such a wonderful day.
[CUSTOMER][POSITIVE] Thank you. You do the same.
[AGENT][POSITIVE] Thanks. Bye-bye.
[CUSTOMER][NEUTRAL] Mm bye-bye.