AccountId: 011433970860
ContactId: 6ee320c2-7a71-4e48-a75c-a5c1c0fd33f2
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 246479 ms
Total Talk Time (AGENT): 117682 ms
Total Talk Time (CUSTOMER): 63612 ms
Interruptions: 0
Overall Sentiment: AGENT=0.8, CUSTOMER=1
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/02/28/6ee320c2-7a71-4e48-a75c-a5c1c0fd33f2_20250228T15:36_UTC.wav
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[AGENT][NEUTRAL] Thank you for calling APL. This is [PII]. How can I help you?
[CUSTOMER][NEUTRAL] Hi [PII] with a K or C?
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] [PII], can I get uh benefits, uh, eligibility deductible out of pocket all of that for this patient that's coming in for a procedure please.
[AGENT][NEUTRAL] Sure, I can check eligibility and benefits uh huh uh what was your name?
[CUSTOMER][NEUTRAL] [PII] last initial [PII]
[AGENT][NEUTRAL] OK, [PII], can I get a good call back number from me first in case we're disconnected?
[CUSTOMER][NEUTRAL] [PII]
[AGENT][NEUTRAL] Thank you. And then do you have the policy number?
[CUSTOMER][NEUTRAL] Policy number 022794007.
[AGENT][NEUTRAL] OK, and then what was the name and date of birth for the insured?
[CUSTOMER][NEUTRAL] [PII], uh, [PII].
[AGENT][NEUTRAL] OK, thank you for verifying that [PII]. Uh, so this policy is active. Effective date was [PII], I'm sorry, [PII], and this is a secondary medical policy, so it is designed to help with co-pay, deductible and co-insurance after major medical pays, and we we needing to look at the outpatient benefit?
[CUSTOMER][NEUTRAL] Yeah, so she, it'll be for outpatient surgery, um.
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] I will say that her she's got like a 6 $6800 primary Blue Cross Blue Shield deductible left. I just wanna know how you guys pay on that.
[AGENT][NEUTRAL] Mhm.
[AGENT][NEUTRAL] Sure, OK, so, uh, of course I will let you know verification of coverage is not a guarantee of payment for claims. So this policy does not have a deductible, um, or anything like that. It simply has the benefit amount, uh, that is yearly uh give me just a moment because I'm seeing the combined amount, um, I'm gonna get the policy pulled up so I can see that individual yearly amount.
[CUSTOMER][NEUTRAL] OK.
[AGENT][POSITIVE] Bear with me just a moment, I appreciate your patience. It's thinking about it.
[CUSTOMER][POSITIVE] No worries.
[AGENT][NEUTRAL] OK, OK, um, so that yearly maximum is $8100 per calendar year.
[AGENT][NEUTRAL] And that is
[AGENT][NEUTRAL] Going to be for all covered persons combined so there's not a individual limit um give me just a moment uh let me see if any of that has been used.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] OK, so [PII] has used $70 of that benefit.
[CUSTOMER][NEUTRAL] OK, and I sincerely apologize, can you repeat the uh maximum amount?
[AGENT][NEUTRAL] No, you're OK.
[AGENT][NEUTRAL] Yes, that's $8100 per calendar year.
[CUSTOMER][POSITIVE] Perfect.
[CUSTOMER][NEUTRAL] OK, well then it looks like that will cover um what is uh.
[AGENT][NEUTRAL] Yeah
[CUSTOMER][NEGATIVE] Not gonna be paid by the primary so.
[AGENT][NEUTRAL] Right, and all we would need is that primary EOB.
[CUSTOMER][NEUTRAL] OK, and primary, OK, and then a question for you, one more question, do we need to, uh, get a prior authorization for a couple of procedure codes?
[AGENT][NEUTRAL] Yes.
[AGENT][NEUTRAL] No authorization is not required for this policy as it's just heavily dependent on whoever she has as major medical as long as they're willing to pay this policy can.
[CUSTOMER][NEUTRAL] Uh
[CUSTOMER][POSITIVE] OK, 0 as required for secondary. Wonderful news. Car. Is there any sort of reference number for our call today?
[AGENT][NEUTRAL] It would just be my first name, last initial, and today's date, uh, so my last initial is [PII] and was there anything else I could help you with there?
[CUSTOMER][POSITIVE] That's it thank you so much.
[AGENT][POSITIVE] Alright, yeah, thanks for calling APL. I hope you have a great rest of your day.
[CUSTOMER][NEUTRAL] You too bye bye.
[AGENT][POSITIVE] Thank you. Bye bye