AccountId: 011433970860
ContactId: 81d29780-30a8-4f16-9b76-df6a3f4c8ca0
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 362309 ms
Total Talk Time (AGENT): 137313 ms
Total Talk Time (CUSTOMER): 131013 ms
Interruptions: 4
Overall Sentiment: AGENT=0.3, CUSTOMER=0.1
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/06/16/81d29780-30a8-4f16-9b76-df6a3f4c8ca0_20250616T19:26_UTC.wav
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[AGENT][NEUTRAL] Good afternoon. Thank you for calling APL. This is [PII]. How may I assist you?
[CUSTOMER][POSITIVE] afternoon. Thank you for calling.
[CUSTOMER][NEUTRAL] Hi, good afternoon. My name is [PII], and I'm calling from Integri Southwest Medical Center, and I didn't catch your name. What was your name again?
[AGENT][NEUTRAL] Mhm.
[AGENT][NEUTRAL] My name is So [PII] last initial [PII]
[CUSTOMER][NEUTRAL] Yeah
[CUSTOMER][NEUTRAL] Hi, OK, um, I would like to check the benefits based on our facilities participation status. Uh, what information do you want from me? The NPA number?
[AGENT][NEUTRAL] Hm
[AGENT][NEUTRAL] Um, no, it's OK. I just need a callback number just in case we get disconnected and the policy number of the patient.
[CUSTOMER][NEUTRAL] OK, so phone number in case the line gets disconnected [PII].
[AGENT][NEUTRAL] OK, what's the patient's policy number?
[CUSTOMER][NEUTRAL] Policy number 02112911.
[CUSTOMER][NEUTRAL] 02112911 under patient [PII].
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] And the birthday [PII].
[AGENT][NEUTRAL] What's the name ma'am.
[AGENT][POSITIVE] OK thank you.
[AGENT][NEUTRAL] And what type of service is being rendered for benefits.
[CUSTOMER][NEUTRAL] Uh, yeah, benefits, outpatient.
[CUSTOMER][NEUTRAL] I just need to check if there's any individual family deductible out of pocket and the co-insurance.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] OK, um, miss, this particular policy is a secondary policy to the major medical, um, this is not the major medical. Um, let me go ahead and give you the outpatient benefits, and this is not a guarantee of payment, just a verification of coverage.
[CUSTOMER][NEUTRAL] the
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] Outpatient maximum is 5000 per covered person per calendar year and there's no deductibles or no out of pocket, right.
[CUSTOMER][NEUTRAL] That's probably.
[CUSTOMER][NEUTRAL] So the maximum is 5000.
[CUSTOMER][NEUTRAL] I'm sorry, is that?
[CUSTOMER][NEUTRAL] It
[CUSTOMER][NEUTRAL] Is that for the individual that um out of pocket or family out of pocket?
[AGENT][NEUTRAL] No, that is the outpatient maximum benefit.
[AGENT][NEUTRAL] Let me check and see what is the family max one.
[CUSTOMER][NEUTRAL] Is that the old
[CUSTOMER][NEUTRAL] Hold on.
[CUSTOMER][NEUTRAL] Uh, how much the outpatient maximum benefits?
[AGENT][NEUTRAL] Outpatient maximum benefit is 5000 per covered person per calendar year.
[CUSTOMER][NEUTRAL] The calendar year
[CUSTOMER][NEUTRAL] OK, what else information?
[AGENT][NEUTRAL] The family max. OK, the family max is 15,000 if it's a family plan.
[AGENT][NEUTRAL] And this is a combined benefit with inpatient and outpatient.
[CUSTOMER][NEUTRAL] I
[CUSTOMER][NEUTRAL] OK, um, do you see any accumulated amount or used amount for a family out of pocket?
[AGENT][NEUTRAL] I can check and see if they have used any of their benefits. One moment.
[CUSTOMER][NEUTRAL] Yeah
[AGENT][NEUTRAL] As of today for [PII], um, she has used $51.40.
[CUSTOMER][NEUTRAL] $4.20.
[CUSTOMER][NEUTRAL] OK, and you did mention earlier that you don't see any individual and family deductible.
[AGENT][NEUTRAL] Correct. And there's no deductible on this one. This is a secondary supplemental plan to the major medical.
[CUSTOMER][NEUTRAL] OK, and what information do you see there? What else?
[AGENT][NEUTRAL] I have a lot of information. What information do you need?
[CUSTOMER][NEUTRAL] But
[CUSTOMER][NEUTRAL] Is there anything else I need to know about this patients coverage that might impact the building for the service?
[AGENT][NEUTRAL] What service is being rendered? Is it an office visit? Is it an outpatient facility? Is it a surgery? Is it urgent care?
[CUSTOMER][NEUTRAL] Out outpatient.
[CUSTOMER][NEUTRAL] Outpatient.
[AGENT][NEUTRAL] Is it an outpatient facility?
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Yes.
[AGENT][NEUTRAL] OK. So the outpatient facility uh is gonna be uh going towards the outpatient benefits. So the outpatient benefit is that 5000 that we cover per calendar year, and this is to help with the deductibles, co-payment, and co-insurance from the major medical.
[CUSTOMER][NEUTRAL] Uh.
[CUSTOMER][NEUTRAL] How.
[CUSTOMER][NEUTRAL] So it's still the same thing with outpatient maximum benefit 5000.
[AGENT][POSITIVE] Correct.
[CUSTOMER][NEUTRAL] Do you see any individual out of pocket or just a family out of pocket?
[AGENT][NEUTRAL] There's not an out of pocket. This is not a major medical.
[CUSTOMER][NEUTRAL] I have the reference number for this conversation.
[AGENT][NEUTRAL] We don't
[AGENT][NEUTRAL] We don't have reference numbers. You can use my name in today's date if you would like.