AccountId: 011433970860
ContactId: 8b37ddcd-5dea-495c-b23b-928ad8179082
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 205029 ms
Total Talk Time (AGENT): 99988 ms
Total Talk Time (CUSTOMER): 84128 ms
Interruptions: 0
Overall Sentiment: AGENT=1.5, CUSTOMER=0.8
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/04/04/8b37ddcd-5dea-495c-b23b-928ad8179082_20250404T18:51_UTC.wav
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[AGENT][POSITIVE] Thank you for calling ATL. This is [PII]. How can I help you?
[CUSTOMER][NEUTRAL] Hi, this is [PII] with Houston Methodist. Um, I'm sorry, I didn't get your name.
[AGENT][NEUTRAL] It's all right. It's [PII] And did you say your name was [PII]?
[CUSTOMER][NEUTRAL] Yes,
[AGENT][POSITIVE] OK, what can we help you with today?
[CUSTOMER][NEUTRAL] Um, I need to get benefits and eligibility on a member.
[AGENT][NEUTRAL] Sure, I can take benefits and eligibility. Um, [PII], can I get a good call back number from you first in case we're disconnected?
[CUSTOMER][NEUTRAL] It's [PII]. I'm sorry, um.
[CUSTOMER][NEUTRAL] [PII]
[AGENT][NEUTRAL] OK, thank you and then do you have the policy number?
[CUSTOMER][NEUTRAL] Policy number is um.
[CUSTOMER][NEUTRAL] 02
[CUSTOMER][NEUTRAL] 580-148
[AGENT][NEUTRAL] OK and then uh what was the name and date of birth for the member please?
[CUSTOMER][NEUTRAL] It's [PII].
[CUSTOMER][NEUTRAL] And the date of birth is [PII].
[AGENT][NEUTRAL] Perfect, thank you for verifying that. Uh, so this policy is active. Effective date was [PII], and this is a secondary medical policy, so it is designed to help with co-pay, deductible and co-insurance after major medical pays, and we're reading to look at the inpatient or outpatient benefits.
[CUSTOMER][NEUTRAL] It's outpatient. She's coming in to see an oncologist, so I need to see what her copay would be.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] So this policy doesn't have uh co-pays or anything like that. It's designed to help with co-pays from major medical, um, and of course I will let you know verification of coverage is not a guarantee of payment for claims, so her total outpatient benefit is $1000 per calendar year.
[AGENT][NEUTRAL] And then if you'll give me one moment I'll see if any of that has been used.
[AGENT][NEUTRAL] OK, none has been used so far this year.
[CUSTOMER][NEUTRAL] OK, now when you say $1000 per calendar year if she has a copay of with her with her um primary, if she has a co-pay of say $80 do you cover that co-pay?
[AGENT][NEUTRAL] Yes.
[AGENT][NEUTRAL] Mhm.
[AGENT][NEUTRAL] So, yes, it's co-pay, deductible and co-insurance, it would pay any of those up to that, yes, up to that $1000 maximum per calendar year.
[CUSTOMER][NEUTRAL] You do.
[CUSTOMER][NEUTRAL] So it's copay.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Deductible.
[CUSTOMER][NEUTRAL] OK, so it pays the co-pay the deductible and co-insurance.
[AGENT][POSITIVE] Correct.
[CUSTOMER][NEUTRAL] Up to $1000.
[AGENT][NEUTRAL] Yes, her calendar year.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][POSITIVE] Excellent, I got it. And 0 has been met so far.
[AGENT][POSITIVE] Correct.
[CUSTOMER][NEUTRAL] All right, great. Um, [PII], can I get a reference number for this call, please?
[AGENT][NEUTRAL] Sure, that would just be my first name, last initial, and today's date. Uh, so my last initial is [PII] Was there anything else I could help you with, [PII]?
[CUSTOMER][POSITIVE] No, that'll be all. Thank you so much for your time. I greatly appreciate it.
[AGENT][NEUTRAL] All right.
[AGENT][POSITIVE] Of course, thanks for calling APL. I hope you have a great weekend.
[CUSTOMER][POSITIVE] Thanks you as well bye bye.
[AGENT][POSITIVE] Thank you. Bye-bye.