AccountId: 011433970860
ContactId: 861014f8-5e79-47af-a707-39bde03704a7
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 182259 ms
Total Talk Time (AGENT): 87285 ms
Total Talk Time (CUSTOMER): 77107 ms
Interruptions: 0
Overall Sentiment: AGENT=1.2, CUSTOMER=2.8
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/04/16/861014f8-5e79-47af-a707-39bde03704a7_20250416T17:59_UTC.wav
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[AGENT][POSITIVE] Thank you for calling APR. This is [PII]. How can I help you?
[CUSTOMER][NEUTRAL] Hi, my name is [PII]. I'm calling from a facility. I've got a patient um with APL secondary to his commercial policy, and he just asked me to call to uh verify his benefits for um a procedure.
[AGENT][NEUTRAL] I'm sure, [PII], I can assist you with benefits. Um first, could I get a good callback number just in case we're disconnected?
[CUSTOMER][NEUTRAL] Sure, phone number is [PII] and it's a direct line.
[AGENT][NEUTRAL] Thank you. Now I need the policy number, please.
[CUSTOMER][NEUTRAL] Sure. It is 094-512-1.
[AGENT][NEUTRAL] And please verify the patient's name and date of birth.
[CUSTOMER][NEUTRAL] Yes, this is for [PII]. Uh, date of birth is [PII].
[AGENT][NEUTRAL] OK. Thank you and just let me advise you that verification of coverage does not guarantee payment of claims. Um, the effective date on this policy was [PII], and I'm showing that the policy is still active. Um, is this for inpatient or outpatient benefits or an office visit?
[CUSTOMER][NEUTRAL] Outpatient hospital.
[AGENT][NEUTRAL] OK, for outpatient, we cover up to $1500 per calendar year and that's for the co-pay, the co-insurance, and the deductible after the primary insurance processes the claim. But there is a $100 deductible that needs to be met first.
[CUSTOMER][NEUTRAL] OK. So I just wanna make sure I understand something. Did you say um this would cover the primary deductible and co-insurance?
[AGENT][NEUTRAL] Um, yes, ma'am. The claim through the, um, primary insurance company will process first and then the provider sends us the EOB um from the primary insurance along with the claim and we cover the remaining.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Got it.
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] All right, and he has a $100 deductible. OK. Is it still outstanding, that deductible?
[AGENT][NEUTRAL] Right.
[AGENT][NEUTRAL] Yes, it is. He hasn't used any of his benefits this year.
[CUSTOMER][NEUTRAL] Oh
[CUSTOMER][NEUTRAL] OK, got it. So it's still the 1000 as well, correct?
[AGENT][POSITIVE] That's correct. Yes, ma'am.
[CUSTOMER][POSITIVE] OK, sounds good. OK, wow, that was so easy. Thank you so much. I think that was everything that I needed. And then is there a call reference number that I use or or just your name in today's date?
[AGENT][NEUTRAL] Yes, ma'am. It'll just be my name and today's date. Um my name is [PII]. It's spelled [PII] My last initial is [PII], and today's date is your reference number. Um, is there anything else I can assist you with?
[CUSTOMER][POSITIVE] Thank you so much.
[CUSTOMER][POSITIVE] No, [PII], you have a wonderful day. I really appreciate you.
[AGENT][POSITIVE] Oh, no problem, [PII]. You too as well. All right, bye.
[CUSTOMER][POSITIVE] Alrighty.
[CUSTOMER][POSITIVE] Thank you bye bye.