AccountId: 011433970860
ContactId: 80512f92-87ca-40a4-9140-9bc27808c766
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 466549 ms
Total Talk Time (AGENT): 202470 ms
Total Talk Time (CUSTOMER): 178389 ms
Interruptions: 4
Overall Sentiment: AGENT=1, CUSTOMER=1
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/04/04/80512f92-87ca-40a4-9140-9bc27808c766_20250404T13:04_UTC.wav
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[AGENT][NEUTRAL] And thank you for calling ATO. This is [PII]. How can I help you?
[CUSTOMER][POSITIVE] Oh my goodness, hello, yes, good morning. I am calling to find out.
[CUSTOMER][NEUTRAL] About um the patients uh benefits for the secondary plan, if it's going to cover or if it's something that uh they have to do on their own.
[AGENT][NEUTRAL] OK, so you're needing to get.
[CUSTOMER][NEUTRAL] I am [PII] from AdventHealth.
[AGENT][NEUTRAL] OK, [PII], so do you need eligibility also as well as benefit?
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Yes, ma'am. Yes, ma'am.
[AGENT][NEUTRAL] Benefits or just benefits?
[CUSTOMER][NEUTRAL] Uh, eligibility and benefit. Yes, ma'am.
[AGENT][NEUTRAL] You need both?
[AGENT][POSITIVE] OK, yes, ma'am. I can help you with those things, [PII]. And what is a good callback number for you?
[CUSTOMER][NEUTRAL] OK, that is [PII].
[AGENT][NEUTRAL] OK, thank you and the member's policy number please, [PII]?
[CUSTOMER][NEUTRAL] OK, that is 02595368.
[AGENT][NEUTRAL] OK thank you just one moment please while I get the member's information pulled up though.
[CUSTOMER][POSITIVE] Thank you.
[AGENT][NEUTRAL] Mhm.
[AGENT][POSITIVE] You're welcome
[AGENT][NEUTRAL] OK, and [PII], any information that I do provide would be a verification of benefits and not a guarantee of payment. What is your
[CUSTOMER][NEUTRAL] I
[AGENT][NEUTRAL] The patient's name please and their date of birth.
[CUSTOMER][NEUTRAL] So.
[CUSTOMER][NEUTRAL] All right, I, I don't know if it's my headset or, or what, but it keeps flipping out right in the middle of your sentence. Um, I did hear you say patient's name is [PII]. Date of birth is [PII].
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] OK, thank you and what I said prior to that was that any information I provide for you will be a verification of benefits and not a guarantee of payment. So I do show that Ms. [PII] is the subscriber on the supplemental policy, and this supplemental policy is active with an effective date of [PII].
[AGENT][NEUTRAL] And what type of benefit information do you need for her? inpatient, outpatient or office?
[CUSTOMER][NEUTRAL] Me
[CUSTOMER][NEUTRAL] OK, so it's gonna be uh inpatient and it is, we are filing, well you said supplemental, um, it is filing secondary to her primary sheriff.
[AGENT][NEUTRAL] OK, so on this policy for an in-hospital admission, the maximum benefit is 3, excuse me, the maximum benefit is $3000 per covered person for per calendar year.
[AGENT][NEUTRAL] And there is no in hospitals deductible per covered person per calendar year.
[AGENT][NEUTRAL] Now, because this
[CUSTOMER][NEUTRAL] OK, so it is.
[AGENT][NEUTRAL] Uh huh go ahead with your question.
[CUSTOMER][NEUTRAL] Uh.
[CUSTOMER][NEUTRAL] It, it pays a straight flat fee of 3000, um, if that's what because her copay for sure is just $3500 so, um, patient will owe the 500.
[AGENT][NEUTRAL] That is
[AGENT][POSITIVE] Yeah, the maximum benefit from the supplemental plan is $3000 per calendar year per covered person with no deductible. Now, because it is a supple.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] mental policy, [PII], when the claim is submitted APL for review.
[AGENT][NEUTRAL] We will also have to have a copy of her primary insurance company's explanation of benefits as well.
[AGENT][NEUTRAL] And
[AGENT][NEUTRAL] Once we have
[AGENT][NEUTRAL] Excuse me, says our claim here at APL, we do have a portal in which you should be able to check our claim status, and that portal website is located at secure.
[AGENT][NEUTRAL] Am public.
[CUSTOMER][NEUTRAL] OK, yeah that'd be something they would billing would do after the fact.
[CUSTOMER][NEUTRAL] Um,
[AGENT][NEUTRAL] Yes, ma'am. I just wanted to make sure that you were aware that that's said. I don't know if you can make a note.
[CUSTOMER][NEUTRAL] In here, all right.
[CUSTOMER][NEUTRAL] Yes, yeah.
[CUSTOMER][NEUTRAL] Um, OK.
[CUSTOMER][NEUTRAL] Hm
[CUSTOMER][NEUTRAL] Um, all right. OK. And, uh, let's see if I can get, uh, get your name and a call reference.
[AGENT][NEUTRAL] Yes.
[CUSTOMER][NEUTRAL] Mhm
[AGENT][NEUTRAL] Yes, ma'am. Again, my name is [PII].
[AGENT][NEUTRAL] And my name and today's date will be your call reference number.
[CUSTOMER][NEUTRAL] All right, and [PII], your first initial to your last name, please?
[AGENT][NEUTRAL] [PII], and then yours, [PII]? Cause if you gave me that I'd
[CUSTOMER][POSITIVE] Perfect.
[CUSTOMER][NEUTRAL] Is [PII].
[AGENT][NEUTRAL] OK, all right.
[CUSTOMER][NEGATIVE] Yeah, I know this, this headset's driving me crazy. I just, I have, it's like every other word I'm up on, you know, so I'm like, I like I said, I don't know if it's my headset or what, but I may, I may be switching out later today.
[AGENT][NEUTRAL] Uh, I, I understand the feeling. I've had to do that recently myself. So this morning, I can't, we can't blame it on you. I'm not sure if it's yours or mine, and it could be a combination of both. So.
[CUSTOMER][NEUTRAL] Uh.
[CUSTOMER][POSITIVE] There you go. That's right, yes. All right, well, thank you so much. I greatly appreciate your help and uh I'll get this, uh, get this all worked up for our patient and let them know that at least it's a whole lot better than it started out being, so she'll she'll get $3000 shaved off of it, so that's good.
[AGENT][NEUTRAL] All right.
[AGENT][POSITIVE] You're welcome, [PII]. Yes, ma'am.
[AGENT][NEUTRAL] OK.
[AGENT][POSITIVE] Uh-huh, yeah, anytime we can get, um, you know, benefits like that, we're, we're all happy. I know I am for sure.
[CUSTOMER][POSITIVE] Same, same here. Well, thank you so much and happy happy Friday.
[AGENT][NEUTRAL] Yes, ma'am.
[AGENT][POSITIVE] Happy Friday to you too, [PII], and if that's all then that I could help you with, uh, this morning, thank you again for calling APL.
[CUSTOMER][POSITIVE] Thank you. Bye-bye now.
[AGENT][POSITIVE] Yes, ma'am. You're welcome. Uh-huh.
[AGENT][NEUTRAL] Bye bye.
[CUSTOMER][NEUTRAL] Mm