AccountId: 011433970860
ContactId: 882ab51a-2776-4093-b9ca-a3d32eebe374
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 269410 ms
Total Talk Time (AGENT): 81809 ms
Total Talk Time (CUSTOMER): 104315 ms
Interruptions: 0
Overall Sentiment: AGENT=0.7, CUSTOMER=0.2
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/01/28/882ab51a-2776-4093-b9ca-a3d32eebe374_20250128T19:18_UTC.wav
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[AGENT][NEUTRAL] Thank you for calling APL. This is [PII]. How can I help you?
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] Mhm
[CUSTOMER][NEUTRAL] Hi, [PII]. This is [PII] calling from Baptist Health Surgeries and a Plantation. I'm here calling in regards to um a patient that has you guys as a secondary. So I wanted to know more or less the benefits as well as if whether you guys cover as a secondary.
[CUSTOMER][NEUTRAL] What are the guidelines?
[AGENT][NEUTRAL] OK, let's take a look. [PII]. Do you have their policy number?
[CUSTOMER][NEUTRAL] Policy number will be 02483111.
[AGENT][POSITIVE] OK, thank you so much. Let me pull this up.
[AGENT][NEUTRAL] Uh
[AGENT][NEUTRAL] Can I get the patient's name and date of birth?
[CUSTOMER][NEUTRAL] Patient's name is [PII] Last name is [PII]
[AGENT][NEUTRAL] Thank you. And your date of birth?
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] Thank you. So the member's plan is active. The effective date if you need that is [PII].
[AGENT][NEUTRAL] So we are the secondary insurance, which means this cover deductible, co-pay, co-insurance, the primary does not.
[AGENT][NEUTRAL] And is the patient being seen on an outpatient basis?
[CUSTOMER][NEUTRAL] Ambulatory surgery center. You said that you guys cover deductible co-insurance and co-pays, right?
[AGENT][NEUTRAL] Mhm. Correct, yeah.
[CUSTOMER][NEUTRAL] Mhm. Is there a limit amount or it's just based after what the primary insurance doesn't cover?
[AGENT][NEUTRAL] Let's see here.
[AGENT][NEUTRAL] OK, so it looks like the um benefit max for the calendar year is 9100.
[CUSTOMER][NEUTRAL] Has the the patient me anything?
[AGENT][NEUTRAL] Let me see if they've used anything this year, one moment.
[CUSTOMER][NEUTRAL] I
[AGENT][NEUTRAL] Uh, looks like they still have the full amount remaining.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] And you guys don't require any.
[CUSTOMER][NEUTRAL] Authorization like.
[AGENT][NEUTRAL] Yeah, no, no pre-authorization is required.
[CUSTOMER][NEUTRAL] It is required?
[AGENT][NEUTRAL] No, it's not. I'm sorry.
[CUSTOMER][NEUTRAL] OK. So,
[CUSTOMER][NEUTRAL] OK, just to make sure the patient has a 9100 max for a calendar year which they have met zero so far. Pre-certification is not required, and the benefits for the patient is only based on deductible coinsur and co-pays as the primary doesn't cover it, correct?
[AGENT][POSITIVE] Mhm, correct.
[CUSTOMER][NEUTRAL] OK. Oh, you say your name was [PII]?
[AGENT][NEUTRAL] Uh yeah, my name is [PII]. It's spelled [PII]
[AGENT][NEUTRAL] And the call reference is my name with my last initial which is [PII].
[CUSTOMER][NEUTRAL] And your
[CUSTOMER][NEUTRAL] OK, so the references.
[CUSTOMER][NEUTRAL] [PII], that's it.
[AGENT][NEUTRAL] Mhm. And then today's date.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][POSITIVE] Perfect. Thank you so much, [PII]. I hope you have a wonderful day.
[AGENT][NEUTRAL] Oh
[AGENT][NEUTRAL] You
[AGENT][POSITIVE] You too, [PII]. Take care. Bye-bye.