AccountId: 011433970860
ContactId: 7b9554a3-f965-4a2d-9bed-30159d470048
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 340059 ms
Total Talk Time (AGENT): 80359 ms
Total Talk Time (CUSTOMER): 108851 ms
Interruptions: 0
Overall Sentiment: AGENT=0.6, CUSTOMER=0.7
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/05/09/7b9554a3-f965-4a2d-9bed-30159d470048_20250509T14:11_UTC.wav
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[AGENT][NEUTRAL] For calling APL, this is [PII]. How may I help you?
[CUSTOMER][NEUTRAL] Hi, my name is [PII]. I'm calling from a provider's office, um.
[CUSTOMER][NEUTRAL] I have a patient who's got um this insurance as a secondary and um one of the benefits uh that I'm calling about is orthotic inserts. Now his primary does not cover orthotic inserts.
[AGENT][NEUTRAL] Mhm.
[AGENT][NEUTRAL] Is that a question?
[CUSTOMER][NEUTRAL] As a secondary.
[CUSTOMER][NEUTRAL] Uh, no, I'm, I'm letting you know they don't cover as a secondary, do you guys cover that or do you follow whatever the primary is?
[AGENT][NEUTRAL] OK, let me get the policy number, [PII].
[CUSTOMER][NEUTRAL] Sure. Uh, let's see.
[CUSTOMER][NEUTRAL] Um, hm, where's the policy number?
[CUSTOMER][NEUTRAL] I have a group number.
[AGENT][NEUTRAL] It should be the outpatient. Give me the outpatient or inpatient policy er number.
[CUSTOMER][NEUTRAL] Oh, I see. OK. Benefit cert number. All right. 01994078 M as in Mary, L as in Larry, 8.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] Yes, ma'am.
[AGENT][NEUTRAL] OK, and what's a good phone number in case we're disconnected?
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] OK, thank you. Give me one moment to pull up the policy [PII] [PII], OK?
[CUSTOMER][NEUTRAL] Sure.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] And verify the patient's name and date of birth for me.
[CUSTOMER][NEUTRAL] Uh, that's gonna be [PII] [PII].
[AGENT][POSITIVE] All right, thank you for that information.
[AGENT][NEUTRAL] OK, and so did I understand you to say that the primary insurance uh is denying that the services as not covered by the policy?
[CUSTOMER][POSITIVE] Correct.
[AGENT][NEUTRAL] OK, so when the primary denies as not covered by the policy, this gap policy does not cover either. Um, this policy covers any amounts, covered amounts applied towards deductible co-insurance and co-pay amounts only.
[CUSTOMER][NEUTRAL] OK, so um
[CUSTOMER][NEUTRAL] OK, now, if it was a covered benefit and he has a deductible, but it hasn't been met.
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Um, he would still be responsible 100%.
[AGENT][NEUTRAL] OK, so if it's applied towards deductible, co-insurance, or co-pay, uh, and it's a cover charge, the gap policy will pick up those amounts up to the policy benefit maximum.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] I see. OK.
[AGENT][NEUTRAL] Mhm, so was it denied is not covered or is it being applied towards the calendar?
[CUSTOMER][POSITIVE] OK, great.
[CUSTOMER][NEUTRAL] No, it's just, no. The, the second part of it, I just ask for my own knowledge because I've never seen this insurance before. Um, but it's a non-covered benefit, yeah, but they wanted me to find out. I mean, I already knew the answer, but they always want me to find out, so, so that I can document it.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] OK, got it.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] Oh, OK.
[AGENT][POSITIVE] OK, well, you were correct. OK. Anything.
[CUSTOMER][NEUTRAL] Um, yeah, OK, great. [PII], uh, can I have a reference number or do I just use your name?
[AGENT][NEUTRAL] Any
[AGENT][NEUTRAL] You'll use my name in today's status reference uh for today's call and did you have any other questions, [PII]?
[CUSTOMER][POSITIVE] No, but thank you for your time.
[AGENT][POSITIVE] Oh, you're welcome. Thanks for calling APL. Have a good day.
[CUSTOMER][NEUTRAL] You too. Bye-bye.