AccountId: 011433970860
ContactId: 87a8fce9-2f16-49cd-883a-3f946f18a48c
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 380570 ms
Total Talk Time (AGENT): 117225 ms
Total Talk Time (CUSTOMER): 106868 ms
Interruptions: 0
Overall Sentiment: AGENT=0.6, CUSTOMER=0.3
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/02/25/87a8fce9-2f16-49cd-883a-3f946f18a48c_20250225T19:09_UTC.wav
--------------------------------------------
[AGENT][NEUTRAL] Thank you for calling APL. This is [PII]. How may I help you?
[CUSTOMER][NEUTRAL] Hi, uh, good afternoon. This is [PII] calling from Nicholas Children's Hospital to get our patients benefits.
[AGENT][NEUTRAL] OK, I can give you benefits, [PII]. um, can I please get your callback number?
[CUSTOMER][NEUTRAL] [PII].
[CUSTOMER][NEUTRAL] [PII].
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] Thank you sir and then what's the patient's name, date of birth, and policy number?
[CUSTOMER][NEUTRAL] Sure. Patient.
[CUSTOMER][NEUTRAL] Their first name is [PII], which is spelled as [PII]
[CUSTOMER][NEUTRAL] The Last name was [PII].
[CUSTOMER][NEUTRAL] Date of birth is [PII].
[CUSTOMER][NEUTRAL] And I have a member ID number of 02556458.
[AGENT][NEUTRAL] OK, let me look that up real quick for us.
[AGENT][NEUTRAL] OK, I do show that [PII] does have an active policy, and the effective date is [PII].
[AGENT][NEUTRAL] And this is just to verify his benefits. It's not a guarantee of payment.
[AGENT][NEUTRAL] This is a supplemental insurance policy. It's a gap insurance that's billed secondary.
[AGENT][POSITIVE] It helps with deductible, co-pay, and co-insurance.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] He has an inpatient benefit amount per calendar year of $8700 and then he also has an outpatient benefit per calendar year also of $8700.
[CUSTOMER][NEUTRAL] So the deductible of $5700 right?
[AGENT][NEUTRAL] $8700.
[CUSTOMER][NEUTRAL] OK. And also you stated that the plan is
[CUSTOMER][NEUTRAL] This one is a supplemental plan like this is a secondary insurance for this patient, right?
[AGENT][POSITIVE] Correct.
[CUSTOMER][NEUTRAL] Hm, OK. Uh, actually, I do verify the patient's primary insurance that is IMed HMO, uh yeah, I met PPO plan. Actually I, I was verified. And for that, uh,
[CUSTOMER][NEUTRAL] For for specialist office visit.
[CUSTOMER][NEUTRAL] For the primary insurance, they cover the co-pay amount of $70. And for the secondary APO will cover which is left over by the primary.
[AGENT][NEUTRAL] No.
[AGENT][NEUTRAL] No. This only helps with deductible. No, this only helps with deductible, co-pay, or co-insurance.
[CUSTOMER][NEUTRAL] So you are
[CUSTOMER][NEUTRAL] Yeah, go ahead.
[CUSTOMER][NEUTRAL] Once patients are satisfied their $8700 deductible, then APL will pay 100%, right?
[AGENT][NEUTRAL] No, that is the benefit for the insured.
[CUSTOMER][NEUTRAL] OK. Can I have the, yeah.
[CUSTOMER][NEUTRAL] Can I have the benefit for the secondary for specialist office visit.
[AGENT][NEUTRAL] I don't know what the uh the outpatient benefit per calendar year is 8700. Let me look to see if office visits are covered under this policy. Give me just a second.
[CUSTOMER][NEUTRAL] Uh huh OK.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] It's going to, I'm gonna pull in the policy itself and read it and see if office visits are covered.
[CUSTOMER][POSITIVE] OK, take your time.
[AGENT][NEUTRAL] Yes, sir.
[AGENT][NEGATIVE] OK, this does not.
[AGENT][NEUTRAL] Cover the physician's office visit.
[CUSTOMER][NEUTRAL] Oh, APL will not go for office visit for this patient, right?
[AGENT][POSITIVE] Correct.
[CUSTOMER][NEUTRAL] OK, no worries. I'm gonna mention in my notes. Uh, can you please spell your name along with your last initial?
[AGENT][NEUTRAL] Yes, it's [PII] and my last initial is [PII]
[CUSTOMER][NEUTRAL] Can I have the call reference number?
[AGENT][NEUTRAL] Yes, it's um.
[AGENT][NEUTRAL] My name is today's date.
[CUSTOMER][POSITIVE] Thank you, [PII]. Uh, thanks for patiently assisting me. I hope you're on the rest of the day ahead.
[CUSTOMER][NEUTRAL] Bye for now.
[AGENT][POSITIVE] You too thank you so much for calling [PII] you have a good day also thanks for calling.
[AGENT][NEUTRAL] Bye-bye, sir.
[CUSTOMER][NEUTRAL] Bye.