AccountId: 011433970860
ContactId: 73fe76f7-5868-4418-900a-25fb5b81fc6c
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 285440 ms
Total Talk Time (AGENT): 131783 ms
Total Talk Time (CUSTOMER): 89124 ms
Interruptions: 0
Overall Sentiment: AGENT=1.3, CUSTOMER=0.1
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/04/04/73fe76f7-5868-4418-900a-25fb5b81fc6c_20250404T18:14_UTC.wav
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[AGENT][NEUTRAL] Thank you for calling APL. This is [PII]. How may I help you?
[CUSTOMER][NEUTRAL] Um, yes, [PII], good afternoon. My name is [PII] and the initial to my last name is [PII].
[AGENT][POSITIVE] OK. Hi, Ms. [PII]. Good afternoon to you too.
[CUSTOMER][NEUTRAL] Hello.
[AGENT][POSITIVE] How can I help you today?
[CUSTOMER][NEUTRAL] I am calling um to.
[CUSTOMER][NEUTRAL] I'm calling to verify.
[CUSTOMER][NEUTRAL] Eligibility and benefits for one of your members and if authorization is required for the procedure patient is having.
[AGENT][NEUTRAL] OK, I can help you with the eligibility benefits and authorization, Ms. [PII]. Can I please get your callback number just in case our call is disconnected?
[CUSTOMER][NEUTRAL] My direct callback number is [PII].
[AGENT][NEUTRAL] Thank you. And then what's the patient's name, date of birth, and policy number?
[CUSTOMER][NEUTRAL] It is going to be.
[CUSTOMER][NEUTRAL] Patient's name and date of birth [PII].
[CUSTOMER][NEUTRAL] And date of birth [PII].
[AGENT][NEUTRAL] OK, and then what's [PII]'s policy number, please?
[CUSTOMER][NEUTRAL] It is 02.
[CUSTOMER][NEUTRAL] 220053
[AGENT][NEUTRAL] OK, that's 0222005. Is that correct?
[CUSTOMER][NEUTRAL] Yes
[AGENT][NEUTRAL] OK, let me look that up real quick.
[AGENT][NEUTRAL] OK, looks like we're missing a digit 0222005.
[CUSTOMER][NEUTRAL] 3, at the end, 3, I'm so sorry.
[AGENT][NEUTRAL] 3.
[AGENT][NEUTRAL] Uh, that's OK. I've got it now.
[AGENT][NEUTRAL] Oh.
[AGENT][NEUTRAL] OK, I do show that [PII] does have an active policy with us. Her effective date is [PII].
[AGENT][NEUTRAL] Uh, no authorization is needed. This is not the primary insurance. This is a supplemental policy. Uh, this is just a yes, this is just to verify her benefits. It's not a guarantee of payment. So it's billed secondary to the primary and helps with deductible, co-pay, and co-insurance.
[CUSTOMER][NEUTRAL] Oh, it's a supplemental policy.
[AGENT][NEUTRAL] She has an inpatient calendar year benefit amount of $2550 and then she also has an outpatient calendar year benefit amount of $2550 to go towards deductible, co-pay or co-insurance.
[CUSTOMER][NEUTRAL] How much is the inpatient you said?
[AGENT][NEUTRAL] $2550 per calendar year.
[CUSTOMER][NEUTRAL] And the outpatient.
[AGENT][NEUTRAL] Is the same amount?
[AGENT][NEUTRAL] Uh, per calendar year.
[CUSTOMER][NEUTRAL] OK, has anything been met for the outpatient ma'am?
[AGENT][NEUTRAL] Let me check.
[AGENT][NEGATIVE] Nothing has been used for the year of [PII].
[CUSTOMER][NEUTRAL] OK
[CUSTOMER][NEUTRAL] Uh
[CUSTOMER][NEUTRAL] So basically like it's a supplemental it takes over, right? Do you know what plan what plan is it?
[AGENT][NEUTRAL] Yes, it's called Medlik, M E D L I N K.
[CUSTOMER][NEUTRAL] Let me
[CUSTOMER][NEUTRAL] Is it a supplemental plan A, B, C?
[AGENT][NEUTRAL] No, no, this is, this stands alone um through APL.
[CUSTOMER][NEUTRAL] No.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEGATIVE] So no deductible, no co-pay, no coinsurance, right?
[AGENT][POSITIVE] Right. It, that's what it helps with.
[CUSTOMER][NEUTRAL] Oh OK.
[CUSTOMER][NEUTRAL] OK, um, may I have a reference number for this call?
[AGENT][NEUTRAL] Yes, ma'am. You can use my name, [PII], and today's date.
[CUSTOMER][NEUTRAL] And then you said your last name [PII]?
[AGENT][NEUTRAL] It's A
[AGENT][NEUTRAL] And Ms. [PII], what's the name of the facility you're calling from?
[CUSTOMER][NEUTRAL] OK
[CUSTOMER][NEUTRAL] Doctor's Hospital at Renaissance.
[AGENT][POSITIVE] OK, thank you.
[CUSTOMER][POSITIVE] Thank you.
[AGENT][POSITIVE] You're welcome. Is there anything else I can help you with before we go?
[CUSTOMER][NEUTRAL] No, that is going to be it.
[AGENT][POSITIVE] OK, well, you have a wonderful weekend and thank you for calling APL Miss [PII].
[CUSTOMER][POSITIVE] Thank you likewise thank you thank you bye bye.
[AGENT][NEUTRAL] Bye-bye, ma'am.