AccountId: 011433970860
ContactId: 6d3e0cf8-aed2-4ff6-970c-2470f1658e8d
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 258209 ms
Total Talk Time (AGENT): 88301 ms
Total Talk Time (CUSTOMER): 95050 ms
Interruptions: 0
Overall Sentiment: AGENT=0.5, CUSTOMER=1.1
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/05/22/6d3e0cf8-aed2-4ff6-970c-2470f1658e8d_20250522T21:12_UTC.wav
--------------------------------------------
[AGENT][NEUTRAL] Thank you for calling APL. This is [PII]. How can I help you?
[CUSTOMER][NEUTRAL] Yeah, hey [PII], uh, my name is [PII] from the skin Cancer Treatment Center. I wanted to see if I could get benefits for one of your insured members.
[AGENT][POSITIVE] Sure, I can help you with some more benefits. Can I get a good callback number in case we get disconnected?
[CUSTOMER][NEUTRAL] Yeah [PII].
[AGENT][NEUTRAL] And do you have the policy number?
[CUSTOMER][NEUTRAL] Yeah, um,
[CUSTOMER][NEUTRAL] The number they gave me was 025689.
[CUSTOMER][NEUTRAL] 89 and then M like Mary L Larry the number 8.
[AGENT][NEUTRAL] OK, one moment.
[AGENT][NEUTRAL] And what's the patient's name and date of birth?
[CUSTOMER][NEUTRAL] Uh, [PII] date of birth [PII].
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] I'm showing this policy is active with an effective date.
[AGENT][NEUTRAL] Of [PII]. This is a Medlink policy, so it's secondary gap insurance, meaning it'll go towards co-pay, co-insurance and deductible. Um, if you're filing a claim under this policy, we will need the primary medicals um explanation of benefits first, showing that benefits have been paid through major medical.
[CUSTOMER][NEUTRAL] OK, and that's what they have. They have United Healthcare, um, so and they got a big deductible I guess my next question was this plan cover anything that's basically done in uh we're, we're gonna be doing a procedure in the physician's office tomorrow and I don't know what what they're what's covered here.
[AGENT][NEUTRAL] Mhm.
[AGENT][NEUTRAL] OK, I can look up their policy and see what they have.
[CUSTOMER][POSITIVE] Thank you.
[AGENT][NEUTRAL] Did you say that it's going to be in a physician's office or an inpatient or outpatient facility?
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] It it it's not an outpatient facility that's for sure, so it's an office, um.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] OK, let me check and see.
[AGENT][NEUTRAL] Mm.
[AGENT][NEUTRAL] I'm not showing any in office.
[AGENT][NEUTRAL] Um, I don't see an in office treatment writer. Uh, it looks like this has inpatient and outpatient benefits.
[CUSTOMER][NEUTRAL] OK, yeah, because, uh.
[CUSTOMER][NEUTRAL] I don't, I don't know either because I, I, I normally the, the APL, some of the APL stuff pays for like office visits, surgeries and stuff like that which I guess is considered outpatient basically but it's not an outpatient facility, you know what I'm saying so um I don't know I guess what we could do is we could, you know, if there's any kind of procedures done I guess we could send it to you and see what you guys think I guess I don't know.
[AGENT][NEUTRAL] Mhm.
[AGENT][NEUTRAL] Yeah.
[AGENT][NEUTRAL] Yeah, I mean, it's better safe to just go ahead and uh submit the claim but to submit that claim we will need the primary um EOB um but just go ahead and send it in and I mean worst case scenario it just gets denied.
[CUSTOMER][NEUTRAL] Right, right.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][POSITIVE] Right, OK, sounds good will do thanks a lot appreciate it.
[AGENT][NEUTRAL] OK, is there anything else I can help you with?
[CUSTOMER][POSITIVE] No, have a good day.
[AGENT][POSITIVE] Great. Thank you for calling APL. Have a great day.
[CUSTOMER][NEUTRAL] Alright bye.
[AGENT][NEUTRAL] Bye.