AccountId: 011433970860
ContactId: 619d46e6-fa4a-49b5-bb4c-5355c5363140
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 335230 ms
Total Talk Time (AGENT): 98379 ms
Total Talk Time (CUSTOMER): 171849 ms
Interruptions: 1
Overall Sentiment: AGENT=0.5, CUSTOMER=0.7
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/06/03/619d46e6-fa4a-49b5-bb4c-5355c5363140_20250603T19:13_UTC.wav
--------------------------------------------
[AGENT][NEUTRAL] Good afternoon. APL. This is [PII]. May I help you?
[CUSTOMER][NEUTRAL] Hey, um, my name is [PII] and I'm calling from, um, a podiatry office, and I'm seeing if, uh, outpatient surgery benefits would be covered under this member secondary insurance.
[AGENT][NEUTRAL] OK, I can verify benefits for you, Ms. [PII], and what is that policy number, please?
[CUSTOMER][NEUTRAL] It's 02584155.
[AGENT][POSITIVE] OK, thank you so much, give me one moment.
[AGENT][NEUTRAL] OK, and do you have a callback number in case the call drops?
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] OK, thank you. And the patient's name, date of birth?
[CUSTOMER][NEUTRAL] [PII] [PII].
[CUSTOMER][NEUTRAL] What was your name [PII]?
[AGENT][NEUTRAL] I'm sorry, it's [PII], last initial [PII]
[CUSTOMER][POSITIVE] Thank you.
[AGENT][NEUTRAL] And I just, you're welcome. I'm showing her effective date is [PII]. She is active on the policy. And so you're needing outpatient benefits, correct?
[CUSTOMER][NEUTRAL] That
[CUSTOMER][NEUTRAL] I
[CUSTOMER][NEUTRAL] Is that the person.
[CUSTOMER][NEUTRAL] I was
[CUSTOMER][NEUTRAL] Yes.
[AGENT][NEUTRAL] Oh, OK, give me one moment.
[AGENT][NEUTRAL] Must be a combined benefit. Give me one moment, I'm sorry.
[CUSTOMER][NEUTRAL] It's OK.
[CUSTOMER][NEUTRAL] I'll throw it away. We don't want one, do we?
[CUSTOMER][NEUTRAL] What's that on the
[AGENT][NEUTRAL] Um, let's see.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Take those plastic things to the supply cabinet.
[CUSTOMER][POSITIVE] Oh never mind, we have more room back here for them.
[CUSTOMER][POSITIVE] Oh there you go, nice and organized.
[AGENT][NEUTRAL] Yeah
[AGENT][NEUTRAL] All right.
[CUSTOMER][NEUTRAL] Won't know until you open it.
[AGENT][NEUTRAL] OK, looks like they have a combined, but um, not a guarantee of payment, just a verification of coverage showing the benefit max up to $3000 per calendar year.
[CUSTOMER][NEUTRAL] Max out of pocket per individual?
[AGENT][NEUTRAL] Yes, ma'am. It's up to 3000 per calendar year.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] And I don't show well I'm looking at him let's see.
[CUSTOMER][NEUTRAL] Um,
[AGENT][NEUTRAL] And I don't sure if she's used any so it is available.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEGATIVE] And net zero.
[CUSTOMER][NEUTRAL] Um
[CUSTOMER][NEUTRAL] Do does it require do outpatient surgery require pre-certification?
[AGENT][NEUTRAL] Uh, no, ma'am.
[CUSTOMER][NEUTRAL] OK, so hold on one second.
[CUSTOMER][NEUTRAL] public.
[CUSTOMER][NEUTRAL] They have a black a $3000.
[CUSTOMER][NEUTRAL] Uh.
[CUSTOMER][NEUTRAL] Mm
[CUSTOMER][NEUTRAL] Did she have an individual deductible under this plan or a family deductible?
[AGENT][NEUTRAL] Uh, there's no deductible.
[AGENT][NEUTRAL] No, ma'am.
[CUSTOMER][NEGATIVE] No deductible under this plan.
[CUSTOMER][NEUTRAL] How much is that for Mr. [PII]? Yes, it's her secondary. Yeah, I know they, they applied deductible to her copay to her office visit.
[CUSTOMER][NEUTRAL] She said they applied the deductible to her office visit when we billed her secondary.
[AGENT][NEUTRAL] Well, the patient doesn't have benefits for office visit. She has benefits for outpatient or in hospital.
[CUSTOMER][NEUTRAL] She doesn't have benefits for office visit under this plan. So she says it's just hospital.
[AGENT][NEUTRAL] Uh, yes, ma'am, outpatient and or in hospital.
[CUSTOMER][NEUTRAL] Outpatient or in hospital. OK, but do they cover the primary deductible? Do they cover the primary insurances?
[AGENT][NEUTRAL] We pick up what
[AGENT][NEUTRAL] We pick up what primary applies towards deductible, co-pay or co-insurance up to that benefit at max.
[CUSTOMER][NEUTRAL] We pick up what applies to up to the benefit max yeah so covers deductible up to max now you want me to write that? OK, covers.
[CUSTOMER][POSITIVE] Deductible up to secondary up to max $3000. OK, I think that's all I needed [PII] except a call reference number and we're good.
[AGENT][NEUTRAL] Uh, if you like, you may use my name at today's date.
[CUSTOMER][POSITIVE] OK, I will. I really appreciate your help. I, I've not dealt with this insurance company before, so I didn't know really what what to ask and what not to ask.
[AGENT][POSITIVE] Oh, you're welcome.
[AGENT][NEUTRAL] No, you're fine. I get it. Yes, ma'am.
[CUSTOMER][NEUTRAL] All right.
[CUSTOMER][POSITIVE] All right, well you have a wonderful day and I appreciate your help.
[AGENT][NEUTRAL] All right.
[AGENT][POSITIVE] Alright, you too, and thank you for calling APL.
[CUSTOMER][NEUTRAL] And that's why it's.
[CUSTOMER][POSITIVE] Thanks bye bye.
[AGENT][NEUTRAL] Bye.