AccountId: 011433970860
ContactId: 7aad53bb-973e-4505-b1c3-c31a27192652
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 275500 ms
Total Talk Time (AGENT): 116389 ms
Total Talk Time (CUSTOMER): 85411 ms
Interruptions: 1
Overall Sentiment: AGENT=1.1, CUSTOMER=1.5
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/05/14/7aad53bb-973e-4505-b1c3-c31a27192652_20250514T19:35_UTC.wav
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[AGENT][NEUTRAL] Thank you for calling APL. This is [PII]. How can I help you?
[CUSTOMER][NEUTRAL] Hi, my name is [PII]. It's [PII] Last initial is [PII]. I'm just calling to verify eligibility and benefits.
[AGENT][POSITIVE] Yeah, I can check eligibility and benefits for you. Uh, [PII], can I get a good call back number from you first in case we're disconnected please?
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] Thank you. And do you have that policy number?
[CUSTOMER][NEUTRAL] Yeah, the patient gave me number 02224116 M for Mary, L for Lima, the number 8.
[AGENT][NEUTRAL] OK, and what was the name and date of birth for the member, please?
[CUSTOMER][NEUTRAL] For [PII], date of birth [PII].
[AGENT][NEUTRAL] Perfect, thank you for verifying that. Uh, so this policy is active. Effective date was [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.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] And we're waiting to look at uh inpatient or outpatient benefits.
[CUSTOMER][NEUTRAL] OK
[CUSTOMER][NEUTRAL] So the patients coming to an outpatient office, um, radiology center? Would that still be considered uh under the benefits?
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] Outpatient, yeah, absolutely, um, let's see, and of course I will let you know verification of coverage is not a guarantee of payment for claims that outpatient benefit is uh $200 per calendar year. Let me verify that. Give me just a moment.
[CUSTOMER][POSITIVE] OK. No problem.
[AGENT][POSITIVE] Bear with me just a moment. I appreciate your patience. I just wanna make sure that that's accurate.
[CUSTOMER][POSITIVE] No, that's OK. Take your time.
[AGENT][POSITIVE] Thank you.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] OK, yeah, um, so that's, it is uh $200 max per calendar year, um, so if you'll give me one moment, I'll see if any of that has been used.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] OK, and this was for [PII] correct?
[CUSTOMER][NEUTRAL] Yes.
[AGENT][NEUTRAL] OK, so so far this year he has used $170 of that benefit, so he has $30 remaining for the calendar year.
[CUSTOMER][NEUTRAL] OK, so technically that really wouldn't apply then because the, so the patient's primary insurance has a $500 co-pay, so they wouldn't pick that up then.
[AGENT][NEUTRAL] Mhm.
[AGENT][NEUTRAL] That's the co-pay, yikes. Well, it would do up to that $200 max, so it would be up to $30 for the remainder of the year.
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] Got it. So they would most likely just pay out the 30 and the patient responsible for the rest?
[AGENT][NEUTRAL] Right, that, um, the limit for the calendar year is 200 and he's used 170.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Hello
[CUSTOMER][NEUTRAL] Yeah, I understand. OK, um, perfect, thank you. And uh just to double check, any prior authorization required for that?
[AGENT][NEUTRAL] Of course.
[AGENT][NEUTRAL] No, um, as this policy is just very dependent on, uh, major medical as long as they're willing to pay this policy can.
[CUSTOMER][POSITIVE] OK, perfect. So.
[CUSTOMER][NEUTRAL] Thank you. And can, do you mind spelling your name for me, Ms. [PII], if that's OK?
[AGENT][NEUTRAL] Of course.
[AGENT][NEUTRAL] Yes, it would just be my first name uh uh if you needed a reference number as well, it would be my first name, last initial and today's date, um, so my name is spelled [PII]
[CUSTOMER][POSITIVE] Perfect. OK. Oh, thank you so much for your help. I hope you have a great day.
[AGENT][POSITIVE] Absolutely. Yeah, thanks for calling APL. You too. Bye bye.
[CUSTOMER][POSITIVE] Thank you. Bye-bye.