AccountId: 011433970860
ContactId: 6f4c0548-f99a-4f6f-9158-6418e4e98741
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 236229 ms
Total Talk Time (AGENT): 113383 ms
Total Talk Time (CUSTOMER): 128146 ms
Interruptions: 3
Overall Sentiment: AGENT=1.1, CUSTOMER=0.8
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/02/24/6f4c0548-f99a-4f6f-9158-6418e4e98741_20250224T23:45_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]. Uh, my name is [PII]. My last initial is [PII]. I'm calling from a facility to check the benefits and eligibility for mutual patient.
[AGENT][POSITIVE] Sure, I can check out really benefits for you. I'm sorry, you said your name was [PII]?
[CUSTOMER][NEGATIVE] Um, sorry, I'm no voice I've been fighting this cold. [PII]
[AGENT][NEUTRAL] It's OK.
[AGENT][NEUTRAL] Oh, got you. OK, sorry about that. Um, it's a wonder not everybody spoke with this crazy the weather's been, um, [PII], can I get a good call back number from you?
[CUSTOMER][NEUTRAL] I know.
[CUSTOMER][NEUTRAL] Everyone except you. So stay well. OK? Don't jinx it.
[AGENT][NEUTRAL] Oh, don't say that.
[AGENT][NEUTRAL] Can I get a good call back number from you?
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] Uh-huh.
[AGENT][POSITIVE] Thank you. Well, my son finally went back to school today, so it's only a matter of time.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][POSITIVE] Stop it. I like that.
[AGENT][NEUTRAL] Um, do you have that policy number, [PII]?
[CUSTOMER][NEUTRAL] Uh uh
[CUSTOMER][NEUTRAL] It is um 01988244 MLD.
[AGENT][NEUTRAL] Got you. And then what was the name and date of birth for the insured?
[CUSTOMER][NEUTRAL] Uh [PII] I can't pronounce the last name. Um date of birth is um [PII].
[AGENT][NEUTRAL] Hm.
[AGENT][NEUTRAL] Perfect. OK, thank you for verifying that. Uh, so this policy is active. Effective date was [PII], and we we needing to look at the outpatient benefits?
[CUSTOMER][NEUTRAL] Um, yeah, he is having, um, uh, uh, well, one of the exams I know is a self-pay, so I'm not even gonna ask you about that. Um, it's echocardiogram, 93306.
[AGENT][NEUTRAL] OK, let's see.
[AGENT][NEUTRAL] And what kind of facility? Is this a regular physician's facility or a hospital?
[CUSTOMER][NEUTRAL] Free standing radiology.
[AGENT][NEUTRAL] Radiology, OK.
[CUSTOMER][NEUTRAL] We build his office.
[AGENT][NEUTRAL] Got you. OK, and then, uh, just so that you are aware, this is a secondary medical policy, so it is designed to help with co-pay, deductible, co-insurance after major medical pays, um, and then of course I will let you know verification of coverage is not a guarantee of payment for claims, uh, so his outpatient benefit is on a per calendar day basis. It pays $500 max per calendar day.
[CUSTOMER][NEUTRAL] Mhm
[CUSTOMER][POSITIVE] Correct.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] OK, great. So that would cover the $50 copay. Um, now, if there is a um
[CUSTOMER][NEGATIVE] Exam that we never built through insurance like a, a calcium score, you know, that we charge a self-pay rate it, that wouldn't help him at all because I know he's gonna ask.
[AGENT][NEUTRAL] Mhm.
[AGENT][NEUTRAL] Um, yeah, so, uh, it was not billed to his major medical?
[CUSTOMER][NEUTRAL] I won, I won't help them with.
[CUSTOMER][NEUTRAL] It will not be billed to his major medical because it's not covered by major medical, so, so it, it right.
[AGENT][NEUTRAL] Ah.
[AGENT][NEUTRAL] Right, so this policy is very dependent on the major medical, yeah, so it can't be used instead. It's just to kind of help major medical out, yes.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][POSITIVE] Correct.
[CUSTOMER][NEUTRAL] OK, so we'll cover the $50 copay on the, on the other on the [PII]. OK, cool.
[CUSTOMER][POSITIVE] All right, that's all I needed.
[AGENT][POSITIVE] Alright, any other questions for me? OK, awesome. Well, I hope you get feeling better soon, [PII]. Hope you have a great rest of your day.
[CUSTOMER][NEUTRAL] Uh,
[CUSTOMER][NEUTRAL] Just uh a call reference mhm.
[AGENT][NEUTRAL] Uh-huh.
[AGENT][NEUTRAL] Sure, that would just be my first name, last initial, and today's date. Uh so my name is spelled [PII] Last initial [PII]
[CUSTOMER][POSITIVE] [PII]. OK. Active and we'll cover the $50 co-pay, OK, or we'll cover copay after major medical. Perfect.
[AGENT][NEUTRAL] Mhm.
[AGENT][NEUTRAL] Right.
[CUSTOMER][POSITIVE] Yeah, OK, great, thank you.
[AGENT][POSITIVE] Alright, yep, thanks for calling APL. Have a great rest of your day.
[CUSTOMER][NEUTRAL] Mm bye bye.
[AGENT][POSITIVE] Thank you bye bye.