AccountId: 011433970860
ContactId: 8349d82c-6006-486f-a8f4-3a76968b7749
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 199500 ms
Total Talk Time (AGENT): 105723 ms
Total Talk Time (CUSTOMER): 44501 ms
Interruptions: 1
Overall Sentiment: AGENT=1.7, CUSTOMER=0.7
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/02/17/8349d82c-6006-486f-a8f4-3a76968b7749_20250217T21:47_UTC.wav
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[AGENT][POSITIVE] Good afternoon. Thank you for calling APL. This is [PII]. How may I assist you?
[CUSTOMER][NEUTRAL] This is [PII] at Orthopedic Institute. I need to get benefits for a patient for an outpatient surgery, please. Hit the deductible and accumulations.
[AGENT][POSITIVE] OK, sure, I can assist you with the eligibility and benefits. And may I have a callback number just in case we get disconnected, Mrs.
[CUSTOMER][NEUTRAL] [PII]
[AGENT][POSITIVE] Thank you.
[AGENT][NEUTRAL] And may I have the patient's policy number?
[CUSTOMER][NEUTRAL] 01930316
[AGENT][POSITIVE] Thank you.
[AGENT][NEUTRAL] May I have the name and date of birth of the patient?
[CUSTOMER][NEUTRAL] [PII] [PII].
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] OK. Let me um start off by giving you the correct policy number. Let me know when you're ready.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] OK, the correct policy number is 0244.
[AGENT][NEUTRAL] 0270.
[CUSTOMER][POSITIVE] All right, thank you.
[AGENT][NEUTRAL] You're welcome. We have an effective date of [PII].
[AGENT][NEUTRAL] And it is active at the moment.
[AGENT][NEUTRAL] And let me check on the benefits and this is not a guarantee of payment, just a verification of coverage and that's just a disclaimer. Um, with this particular policy, there is an outpatient maximum of 6250 with the deductible of 1000 per year.
[AGENT][NEUTRAL] Let me check and see if she has met that deductible or use any of her benefits. OK, one moment.
[AGENT][NEUTRAL] OK, as of today, she has not used her benefits or met that the the deductible, so she still have the 1000 due and the 6250 available.
[CUSTOMER][NEUTRAL] And then after, after the deductible what do y'all pay up to max.
[AGENT][NEUTRAL] Up to 6150.
[CUSTOMER][NEUTRAL] But 100% after deductible?
[AGENT][NEUTRAL] It's gonna be um the amounts applied towards the deductible co-payment and co-insurance up to 6250.
[CUSTOMER][NEUTRAL] Um
[CUSTOMER][NEUTRAL] So yeah, after the deductible you'll pay 100% up to 6250.
[AGENT][NEUTRAL] OK. When you say 100%, you mean 100% of the deductible amount applied towards the main members um responsibility from the major medical? Yes, uh, yeah, I can only say the 6250 is the maximum, yeah. I cannot guarantee anything over the phone. You're welcome. Is there anything else I can help you?
[CUSTOMER][NEUTRAL] Uh-huh.
[CUSTOMER][NEUTRAL] Right, OK.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][POSITIVE] All right, thank you. Bye bye.