AccountId: 011433970860
ContactId: 7d196ccb-0129-4d8e-9dde-f691726b6ff9
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 183020 ms
Total Talk Time (AGENT): 100388 ms
Total Talk Time (CUSTOMER): 60302 ms
Interruptions: 1
Overall Sentiment: AGENT=0.8, CUSTOMER=0.2
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/06/24/7d196ccb-0129-4d8e-9dde-f691726b6ff9_20250624T19:42_UTC.wav
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[AGENT][NEUTRAL] Calling APL, my name is [PII]. How can I assist you today?
[CUSTOMER][NEUTRAL] Uh yes, my name is [PII]. I'm calling to try to verify benefits and eligibility on a patient, please.
[AGENT][POSITIVE] I'd be happy to assist with benefits and eligibility today [PII]. I can get a good call back number for you.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Sure it's [PII]. My [PII] is [PII].
[AGENT][NEUTRAL] And what is the policy number?
[CUSTOMER][NEUTRAL] I have 02515490.
[AGENT][NEUTRAL] Patient's name and date of birth.
[CUSTOMER][NEUTRAL] [PII], [PII].
[AGENT][NEUTRAL] Thank you for that information. Please be advised the verification of coverage is not a guarantee of payment. I do show the policy is currently active. Effective date is [PII]. Now will this be for inpatient or outpatient benefits?
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Um, outpatient
[AGENT][NEUTRAL] I do show the outpatient calendar, your maximum is $5000. Patient also has a deductible of $100. Let me check to see if they've met that yet. One moment.
[CUSTOMER][NEUTRAL] Yes ma'am.
[AGENT][NEUTRAL] Um, so I do show they haven't, um, met the deductible, so they will need the $100 deductible and also they haven't used any benefits, so they have the full amount available.
[CUSTOMER][NEUTRAL] OK, so, um.
[CUSTOMER][NEUTRAL] Can you explain, does, does he have to meet this deductible first before he starts using the 5000?
[AGENT][NEUTRAL] Um, so if we get a claim, um, and his co-pay or co-insurance or deductible is $500 then we're gonna pay $400 and $100 will apply to his deductible.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] OK, so we must meet that deductible before.
[AGENT][NEUTRAL] And then the next time we get a claim, right, and then the next time we get a claim, we'll just pay whatever at 100%.
[CUSTOMER][NEUTRAL] Uh-huh.
[CUSTOMER][NEUTRAL] And then it will be paid at 100% up to that 5000.
[AGENT][NEUTRAL] The next time we get a claim. So if he's coming in and you know you've contacted his major medical and the major medical said, well, he hasn't met his deductible, um, and the deductible is 500, um, then once you get that you'll be back from the major medical, you'll bill us and then we're gonna process it, apply $100 to the deductible, and then pay $400.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK, uh, understand, and I think that will do, and can I get a call reference number?
[AGENT][NEUTRAL] Reference is just my name [PII] last initial [PII], and the date and time of the call. Was there anything else I could assist with today?
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] That will do.
[AGENT][POSITIVE] Thank you for calling APL. You have a good day. Mhm.
[CUSTOMER][POSITIVE] Uh, thank you.
[CUSTOMER][NEUTRAL] You too bye bye.
[AGENT][NEUTRAL] Mhm.