AccountId: 011433970860
ContactId: 85e3de7d-49df-408f-84b9-2e517f7d701b
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 197910 ms
Total Talk Time (AGENT): 129659 ms
Total Talk Time (CUSTOMER): 45468 ms
Interruptions: 0
Overall Sentiment: AGENT=1.5, CUSTOMER=1.3
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/03/03/85e3de7d-49df-408f-84b9-2e517f7d701b_20250303T17:25_UTC.wav
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[AGENT][NEUTRAL] Good afternoon. Thank you for calling APL. This is [PII]. How may I help you today?
[CUSTOMER][NEUTRAL] Hi, good morning. I'm calling to see if a patient's uh coverage uh for the gap insurance.
[AGENT][POSITIVE] OK, I'd be glad to help you. Go and give me your name and the member's policy number, please.
[CUSTOMER][NEUTRAL] Yes, my name is [PII]. Last initial is [PII], and the policy number for the patient is 02217100.
[AGENT][POSITIVE] All right, [PII], thank you so much for that information. Now while I'm pulling this up, go ahead and give me a good return telephone call number.
[CUSTOMER][NEUTRAL] [PII]
[AGENT][NEUTRAL] Alright, [PII], thank you for that information. And what is your patient's name and date of birth today, please, ma'am?
[CUSTOMER][NEUTRAL] [PII].
[CUSTOMER][NEUTRAL] The date of birth is [PII].
[AGENT][NEUTRAL] Alrighty, thank you for that information. Yeah, it looks like she is the insured on this medical supplemental plan, but it looks like she did flip to a different number. So hang on just a second. Let me get it pulled up right quick.
[AGENT][NEUTRAL] Let's see.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] Yes, she flipped a different number. OK, first off, let me give you the correct policy number now. Uh, that is effective [PII]. Her policy number now is going to be 025.
[AGENT][NEUTRAL] 49523.
[CUSTOMER][NEUTRAL] OK, 02549523.
[AGENT][NEUTRAL] Yes ma'am, that is correct. And I like I said, this did go into effect on her supplemental plan 11-12024. She is active and current, but I must advise that verification of coverage is not a guarantee of payment on the claim, but you did say you want to check eligibility. Are there you want to check benefits as well?
[CUSTOMER][NEUTRAL] Uh, yeah, to see the coverage for um a bone density and an X-ray exam, please.
[AGENT][NEUTRAL] What was she gonna have it done at the hospital or doctor's office?
[CUSTOMER][NEUTRAL] An outpatient facility.
[AGENT][NEUTRAL] Outpatient facility. OK, let me get over to her benefits. Let's see. And of course what we are is her medical supplemental plan. So the only thing that we would pick up and pay on is anything for sickness and injury that is applied towards her deductible co-pay or co-insurance at her primary, nothing routine here is covered no matter what.
[AGENT][NEUTRAL] Now her outpatient benefit here is gonna be no pre-cert, no deductible, and she has a $6000 benefit payable per calendar year.
[CUSTOMER][POSITIVE] OK, perfect. Um, has any of that been used yet?
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] Let's see. No, ma'am, as of today, none.
[CUSTOMER][POSITIVE] All right, perfect.
[AGENT][NEUTRAL] OK, was that all I can help you with today, [PII]?
[CUSTOMER][NEUTRAL] Yes, um, is there a reference number for the call?
[AGENT][NEUTRAL] No. No, we don't give reference number, but you can use my name in today's date and my name is [PII] spelled [PII]
[CUSTOMER][POSITIVE] Perfect. Thank you so much for your help.
[AGENT][POSITIVE] Yes, ma'am, [PII], and thank you for calling APO. You have a great rest of your day.
[CUSTOMER][NEUTRAL] You as well. Bye bye.
[AGENT][POSITIVE] Thank you, ma'am. Bye-bye.