AccountId: 011433970860
ContactId: 6bdea537-11d5-4ddb-9574-692c2a04bfed
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 275690 ms
Total Talk Time (AGENT): 106907 ms
Total Talk Time (CUSTOMER): 92410 ms
Interruptions: 0
Overall Sentiment: AGENT=0.9, CUSTOMER=0.6
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/06/12/6bdea537-11d5-4ddb-9574-692c2a04bfed_20250612T21:15_UTC.wav
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[AGENT][POSITIVE] Good afternoon. Thanks for calling APL. This is [PII]. May I help you?
[CUSTOMER][NEUTRAL] Hey, my name is [PII]. I'm calling with Mississippi Sports Medicine to get benefits for a patient.
[AGENT][NEUTRAL] OK, I can verify benefits for you. And Ms. [PII], what is the policy number, please?
[CUSTOMER][NEUTRAL] Yes.
[CUSTOMER][NEUTRAL] 1098614
[AGENT][NEUTRAL] Thank you. And do you have a callback number in case the call drops?
[CUSTOMER][NEUTRAL] Um, [PII].
[AGENT][POSITIVE] OK, thank you, ma'am. Give me one moment.
[AGENT][NEUTRAL] And the patient's name, date of birth?
[CUSTOMER][NEUTRAL] Um, the patient's name is [PII]. His date of birth is
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] Uh let me see. I'm showing that policy number you gave it terminated [PII]. However, I do show an active policy, and I give you that number when you're ready.
[CUSTOMER][NEUTRAL] I
[CUSTOMER][NEUTRAL] OK, what is that policy number?
[AGENT][NEUTRAL] 203.
[AGENT][NEUTRAL] 0125.
[AGENT][NEUTRAL] Effective date [PII] and the policy is active.
[AGENT][NEUTRAL] And what benefits are needing for the patient?
[CUSTOMER][NEUTRAL] Um, professional surgical benefits and ambulatory surgical benefits.
[AGENT][NEUTRAL] OK, um, not a guarantee of payment, just a verification of coverage. With the policy as secondary, we help with primary insurance deductible, co-pay, and or co-insurance. Patient has a benefit max up to $5000 per calendar year, and they do have a $100 deductible for outpatients.
[CUSTOMER][NEUTRAL] And do they have uh just a deductible for the year at all to me like and it's that $100?
[AGENT][NEUTRAL] Uh, just $100 for outpatient.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] $100 deductible so it covers their $5000 that they would owe with that primary pretty much, right?
[AGENT][NEUTRAL] Of deductible of what the primary applies towards deductible, co-pay or co-insurance.
[AGENT][NEUTRAL] Up to that max.
[CUSTOMER][NEUTRAL] So the patient's primary insurance has been paying a $5000 deductible.
[CUSTOMER][POSITIVE] So this plan, it lowers that deductible to $100.
[AGENT][NEUTRAL] Uh, I guess so, yes.
[CUSTOMER][NEUTRAL] OK, um, so after that $100 is met, do they have co-insurance?
[AGENT][NEUTRAL] OK, like I said, we just pay up to that $5000. Once they've met that $5000 benefit, then there's no more benefits for the year.
[CUSTOMER][NEUTRAL] So they have to pay out 5000?
[AGENT][POSITIVE] No, ma'am, they have a benefit with us as secondary of 5000.
[CUSTOMER][NEUTRAL] So you, OK, so y'all only cover the $5000 deductible, correct?
[AGENT][NEUTRAL] We pick up what primary applies for deductible, co-pay, or co-insurance up to the $5000 benefit max he has with us.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Has he met any of his $100 deductible?
[AGENT][NEUTRAL] Uh, one moment.
[AGENT][NEUTRAL] Uh, no, ma'am, and he has not met any of his benefit max for the year.
[CUSTOMER][POSITIVE] All right, thank you so much and can I get a reference number for this call?
[AGENT][NEUTRAL] Uh, if you like, you may use my name at today's date.
[CUSTOMER][NEUTRAL] Uh.
[CUSTOMER][NEUTRAL] Alright, and can you spell that for me?
[AGENT][NEUTRAL] [PII] last initial [PII].
[CUSTOMER][POSITIVE] Great thank you so much. You have a great day.
[AGENT][POSITIVE] Alright you too thanks for calling APO bye.
[CUSTOMER][NEUTRAL] Right
[CUSTOMER][NEUTRAL] Bye bye.