AccountId: 011433970860
ContactId: 7da110f5-43fb-46dd-bc02-f969c2126688
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 257350 ms
Total Talk Time (AGENT): 77985 ms
Total Talk Time (CUSTOMER): 85198 ms
Interruptions: 0
Overall Sentiment: AGENT=1, CUSTOMER=0.9
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/05/07/7da110f5-43fb-46dd-bc02-f969c2126688_20250507T16:47_UTC.wav
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[AGENT][NEUTRAL] Thank you for calling APL. This is [PII]. How can I help you?
[CUSTOMER][NEUTRAL] Hi [PII], I am calling to outpatient surgery benefits for billing for one of your.
[AGENT][POSITIVE] OK, I can help you with benefits. Um, can I get your name and a good callback number?
[CUSTOMER][NEUTRAL] Sure, my name is [PII] and that's spelled [PII]
[CUSTOMER][NEUTRAL] And my callback number is [PII].
[AGENT][NEUTRAL] OK, thank you, [PII]. Do you have the policy number of the patient?
[CUSTOMER][NEUTRAL] I do it's 02519567.
[AGENT][NEUTRAL] Patient name and date of birth?
[CUSTOMER][NEUTRAL] [PII]. Date of birth [PII].
[AGENT][NEUTRAL] OK, it looks like this policy is effective [PII]. It's currently active.
[AGENT][NEUTRAL] And let me pull up those benefits.
[AGENT][NEUTRAL] And did you say that was for outpatient services?
[CUSTOMER][NEUTRAL] Yes ma'am, outpatient surgery for professional billing.
[AGENT][NEUTRAL] OK, it's not a guarantee of payment, basic outline of the policy.
[AGENT][NEUTRAL] Uh, let's see.
[AGENT][NEUTRAL] So this covers for um outpatient hospital services and facility services.
[AGENT][NEUTRAL] Um, they have a $2,025.
[AGENT][NEUTRAL] Um, let's see.
[AGENT][NEUTRAL] Her calendar year maximum that's payable after primary processes the claim.
[CUSTOMER][NEUTRAL] So is that uh is that family out of pocket?
[AGENT][NEUTRAL] Uh, no, it's, it pays. So once primary processes the claim, anything that's left over like deductible co-insurance, this plan will come in and pick up up to $2,000,025 in a calendar year.
[CUSTOMER][NEUTRAL] For individual.
[CUSTOMER][NEUTRAL] But that's the out of pocket.
[AGENT][NEUTRAL] No, it's the amount payable.
[AGENT][NEUTRAL] That's what we'll pay.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] It's like a gap plan, like a secondary gap insurance.
[CUSTOMER][NEUTRAL] Oh
[CUSTOMER][NEUTRAL] OK, after primary page.
[AGENT][NEUTRAL] Yes.
[CUSTOMER][NEUTRAL] Like a secondary gap insurance, OK, got you. So you, you'll pay up to $2,025 after primary pays. OK, got you.
[AGENT][POSITIVE] Correct, yeah.
[CUSTOMER][NEUTRAL] Is there anything?
[CUSTOMER][NEUTRAL] Oh.
[CUSTOMER][NEUTRAL] That you can tell me about the policy is, is that all regarding this policy? You just a gap pretty much a gap insurance and that and that's the max that you'll pay.
[AGENT][POSITIVE] Correct, yes, that's right.
[CUSTOMER][POSITIVE] OK, alrighty.
[CUSTOMER][NEUTRAL] What I was needing to know because I just bring it on.
[CUSTOMER][NEUTRAL] As a secondary, so that's why I was calling to get these benefits.
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Alrighty, and Ms. [PII], may I have the first initial of your last name and the reference number for our call today?
[AGENT][NEUTRAL] Uh, first initial to my last name is [PII], and it's just my name, [PII] and today's date for the reference.
[CUSTOMER][POSITIVE] Thank you so much, Ms. [PII]. I do appreciate your time and your assistance today, and you have a wonderful day.
[AGENT][POSITIVE] Thank you for calling APL. I hope you have a great day too.
[CUSTOMER][POSITIVE] Thank you bye bye.