AccountId: 011433970860
ContactId: 7845c0db-59e1-4962-9177-3ee6a2944ad9
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 260940 ms
Total Talk Time (AGENT): 134216 ms
Total Talk Time (CUSTOMER): 103034 ms
Interruptions: 2
Overall Sentiment: AGENT=1, CUSTOMER=0.4
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/06/17/7845c0db-59e1-4962-9177-3ee6a2944ad9_20250617T12:54_UTC.wav
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[AGENT][POSITIVE] Good morning. Thank you for calling APL. My name is [PII]. How may I help you?
[CUSTOMER][NEUTRAL] Hi, [PII]. My name is [PII]. I am calling, um, I have a question concerning the patient's benefits for outpatient.
[AGENT][NEUTRAL] OK, I can help you with the outpatient benefits, and [PII], may I have a good contact number in case we're disconnected and the policy number?
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] [PII]
[AGENT][NEUTRAL] Thank you. And the policy number?
[CUSTOMER][NEUTRAL] 02595732
[AGENT][NEUTRAL] Thank you, hold on one moment.
[AGENT][NEUTRAL] And can you verify the member's first and last name and date of birth?
[CUSTOMER][NEUTRAL] [PII], [PII].
[AGENT][NEUTRAL] Thank you for that and all the information provided is a verification of benefits, not a guarantee of payment. And what questions did you have about the outpatient benefits?
[CUSTOMER][NEUTRAL] OK, uh, I received benefits early and I know for outpatient surgery, he has a $1000 deductible. Does it pay at 100% of the co-insurance after that deductible, or is it a different percentage?
[AGENT][NEUTRAL] Oh, no, it depends on the, so the secondary policy has its own benefits as well. So once the deductible is met, let me see, I'm waiting for the um
[AGENT][NEUTRAL] Full benefits so I can see exactly what's for the surgery, but it will only be up to whatever the amount is for surgery. I'm waiting for it to come up now.
[CUSTOMER][MIXED] Yeah, because they gave me $1000 deductible and a $6900 max, but I didn't get uh whether or not it would pay 100% like inpatient would pay 100% of the coinsurance.
[AGENT][NEUTRAL] Right, no, it.
[AGENT][NEUTRAL] So there's no way for us to guarantee if it will be at 100%. It's just gonna be up to that 6900.
[AGENT][NEUTRAL] So we can't guarantee that it's 100% until the claim is processed, but they do have that max after the deductible is met.
[AGENT][NEUTRAL] Did you want me to see if they've met their deductible for the year?
[CUSTOMER][NEUTRAL] Hm
[CUSTOMER][NEUTRAL] Yes, ma'am. You can check. I'm, I'm not understanding.
[CUSTOMER][NEUTRAL] So you just
[AGENT][NEUTRAL] So I can't guarantee that something is going to be covered at 100% because we're not claims examiners. So the only way to definitely let you tell you that it will be at 100% is to process the claim.
[CUSTOMER][NEUTRAL] Because it is.
[CUSTOMER][NEUTRAL] OK, yeah, I.
[CUSTOMER][NEUTRAL] But what is, what are his benefits percentage wise after the deductible is met? I understand that it's not a.
[AGENT][NEUTRAL] There is none, because this is the, so this is their secondary insurance, so it, I know what you're asking like 80/20, this isn't primary, we just have that max. So after the deductible is met, we can pay up to the $6900. What that amount is, we don't know until we process the claim.
[CUSTOMER][POSITIVE] Correct.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] I
[CUSTOMER][NEUTRAL] OK, so he just bought a policy, not knowing if it would pick up the rest of his co-insurance. OK.
[AGENT][NEUTRAL] Well, we pay towards the copay, deductible and co-insurance after primary. You're asking a particular amount, I can't answer that until we process the claim.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Mhm
[CUSTOMER][NEUTRAL] OK. All right, well, I'll just mark that um when I got the benefits, she told me that he still had a $1000 remaining on that outpatient deductible.
[AGENT][NEUTRAL] Did you want me to check on the deductible for you? I mean, I understand the question. I just, I, I don't have the answer to that because we haven't processed it yet, so I don't know exactly what we will pay out. We just have that max.
[CUSTOMER][NEUTRAL] Yeah, I just have never had an insurance company tell me that they didn't know what percentage they would pay the co-insurance that if they're secondary. So, uh, you can go ahead and let me know if he's accumulated anything towards that deductible.
[AGENT][NEUTRAL] Right, we, we just don't have percentages.
[AGENT][POSITIVE] Thank you. Hold on one moment.
[AGENT][NEUTRAL] Um, and so far for [PII], he hasn't used any of the max or met the deductible.
[CUSTOMER][NEUTRAL] OK, and your name is?
[AGENT][NEUTRAL] My name is [PII] [PII].
[CUSTOMER][POSITIVE] All right, thank you.
[AGENT][POSITIVE] You're welcome. Was there anything else I can help with?
[CUSTOMER][NEUTRAL] No, ma'am.
[AGENT][POSITIVE] Alright, thanks for calling APL Miss [PII] have a good day.
[CUSTOMER][NEUTRAL] OK bye bye.
[AGENT][NEUTRAL] OK.