AccountId: 011433970860
ContactId: 5bc1ea20-7503-4462-9a3f-8d396f32c113
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 200470 ms
Total Talk Time (AGENT): 95616 ms
Total Talk Time (CUSTOMER): 101984 ms
Interruptions: 3
Overall Sentiment: AGENT=1.4, CUSTOMER=0.2
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/04/22/5bc1ea20-7503-4462-9a3f-8d396f32c113_20250422T14:29_UTC.wav
--------------------------------------------
[AGENT][NEUTRAL] Thank you for calling APL. This is [PII]. How can I help you?
[CUSTOMER][NEUTRAL] Hi, good morning, [PII]. My name is [PII]. I'm calling from a doctor's office, um, in [PII], and I just need to check eligibility on a patient.
[AGENT][NEUTRAL] OK, I could check eligibility for you. Uh, [PII], can I get a good call back number from you first in case we're disconnected?
[CUSTOMER][NEUTRAL] Sure, the number is [PII].
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] Thank you and then do you have that policy number?
[CUSTOMER][NEUTRAL] Um, I do. It is 022.
[CUSTOMER][NEUTRAL] 605-08 M as in Mary, L as in Larry, 8.
[AGENT][NEUTRAL] OK and then what was the name and date of birth for the member please?
[CUSTOMER][NEUTRAL] [PII] [PII].
[AGENT][NEUTRAL] Perfect, thank you for verifying that. So this policy is active. Effective date was [PII].
[AGENT][NEUTRAL] And this is a secondary medical policy, so it is designed to help with co-pay, deductible and co-insurance after major medical pays.
[CUSTOMER][NEUTRAL] So it's a secondary medical policy you said?
[AGENT][POSITIVE] Correct.
[CUSTOMER][NEUTRAL] OK, and it helps with co-pays, deductibles?
[AGENT][NEUTRAL] Yes, and coinsurance.
[CUSTOMER][NEUTRAL] And co-insurance and coinsurance, OK, so we would bill his primary and then you guys, um, would help with whatever is left over if anything.
[AGENT][NEUTRAL] Correct, correct, so there is a maximum, um, let's see, give me just a moment, there's a maximum benefit amount uh for either inpatient or outpatient um it's a yearly maximum, so it's not that it would pay at 100% per se, um, of course I will let you know verification of coverage is not a guarantee of payment for claims.
[CUSTOMER][NEUTRAL] Got you, OK.
[CUSTOMER][NEUTRAL] Uh
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] So inpatient and outpatient both have a maximum of $5000 per calendar year. That's the total benefit amount we would pay.
[CUSTOMER][NEUTRAL] That you would pay OK yearly max, alrighty, um, OK, I mean that's pretty much all I needed to know. I just needed to make sure that the secondary was active because I do have his primary, but he was, um, informing me that he has a secondary. So, um, then what we do is we build his Blue Cross Blue Shield and then because he's telling me it seems like you guys probably take care of his co-pay from the Blue Cross Blue Shield part.
[AGENT][POSITIVE] Correct.
[AGENT][NEUTRAL] Sure.
[AGENT][NEUTRAL] Right.
[AGENT][NEUTRAL] Mhm.
[AGENT][NEUTRAL] Yes, co-pay deductible and co-insurance. Oh right, yes, so we would just need that EOB from uh his primary.
[CUSTOMER][NEUTRAL] Because we were billing him for a co-payment.
[CUSTOMER][NEUTRAL] Right.
[CUSTOMER][NEUTRAL] From primary, OK, so we'll, I'm gonna add the secondary, we'll bill his um Blue Cross Blue Shield and then they'll send you guys the difference for that copay.
[AGENT][POSITIVE] Perfect. Alright, was there anything else I can help you with?
[CUSTOMER][NEUTRAL] OK, alright, and is there a reference number or anything?
[AGENT][NEUTRAL] Oh sure, that would be my first name, last initial and today's date. Uh so my name is spelled [PII]
[CUSTOMER][NEUTRAL] He's gonna stop.
[CUSTOMER][NEUTRAL] OK, so [PII] and then you said today's date?
[CUSTOMER][POSITIVE] [PII] alright perfect [PII] alright um thank you so much for your help that's all we needed.
[AGENT][POSITIVE] Correct.
[AGENT][POSITIVE] Of course, thanks for calling APL have a great rest of your day.
[CUSTOMER][NEUTRAL] Oh
[CUSTOMER][NEUTRAL] You too bye.
[AGENT][NEUTRAL] Bye bye.