AccountId: 011433970860
ContactId: 8c488691-38ca-4826-abe1-a0ab3ba974ad
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 347220 ms
Total Talk Time (AGENT): 154589 ms
Total Talk Time (CUSTOMER): 84851 ms
Interruptions: 0
Overall Sentiment: AGENT=1.2, CUSTOMER=3.5
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/01/06/8c488691-38ca-4826-abe1-a0ab3ba974ad_20250106T17:15_UTC.wav
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[AGENT][NEUTRAL] Thank you for calling APL. This is [PII]. How may I help you?
[CUSTOMER][NEUTRAL] Hi, I'm calling to get benefits for one of our patients, please.
[AGENT][POSITIVE] OK, I can help you with benefits. Can I please get your name and your callback number just in case our call is disconnected?
[CUSTOMER][NEUTRAL] It's [PII], callback number is [PII].
[AGENT][POSITIVE] Thank you, Ms. [PII]. And what is the patient's name?
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] OK, and then what's [PII]'s date of birth?
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] And her policy number, please.
[CUSTOMER][NEUTRAL] 02312664
[AGENT][NEUTRAL] OK, let me look her up real quick.
[AGENT][NEUTRAL] OK, I do show that [PII] does have an active policy. Her effective date is [PII].
[AGENT][NEUTRAL] And this is just to verify benefits it's not a guarantee of payment. This is a supplemental insurance policy that is secondary to the primary. It helps with the deductible, co-pay and co-insurance. She has an inpatient benefit amount of $7900 per calendar year, and she has an outpatient benefit amount of $4000 per calendar year.
[CUSTOMER][NEUTRAL] Perfect. And would diagnostic ultrasounds that are gonna be done in specialized, I I'm sorry, in specialist office be covered under that outpatient benefit?
[AGENT][NEUTRAL] Let me look on her policy and um find out exactly.
[AGENT][NEUTRAL] OK. Let's.
[CUSTOMER][POSITIVE] Perfect, cause it would be for pregnancy, so I just wanted to make sure cause she's definitely gonna be getting some ultrasounds done.
[AGENT][NEUTRAL] Right, OK, let me pull in her policy and see what she has covered as far as uh facilities for her out patient procedures.
[CUSTOMER][POSITIVE] Perfect.
[AGENT][NEUTRAL] It's gonna be just a second because it's going to load her complete policy for me so it's gonna be just a moment while the computer does that and for me to find her outpatient benefits and read them off to you.
[CUSTOMER][POSITIVE] Thank you
[CUSTOMER][NEUTRAL] It's all right, don't worry. You had told me that she hasn't mean nothing. I'm sorry, she hasn't used anything so far for the outpatient or inpatient, right?
[AGENT][NEUTRAL] Let me look for um [PII].
[CUSTOMER][NEUTRAL] Yeah, for her active policy now.
[AGENT][NEUTRAL] Right, let me look real quick for.
[AGENT][NEUTRAL] Nothing has been used, you're correct.
[CUSTOMER][POSITIVE] OK, perfect.
[AGENT][NEUTRAL] OK, so,
[AGENT][NEUTRAL] I'm looking at our policy now I'm trying to find that information for you.
[CUSTOMER][POSITIVE] No problem.
[AGENT][POSITIVE] Yes, she does have benefits if covered in um in an office for uh.
[AGENT][NEUTRAL] Acnes or accident or sickness which pregnancy is considered sickness with this plan.
[AGENT][NEUTRAL] So uh it looks like she's going to be OK.
[AGENT][NEUTRAL] She does not have
[CUSTOMER][POSITIVE] Perfect. And since it does.
[AGENT][NEUTRAL] Yeah. She does not have durable medical equipment, and that's the thing that I see as far as uh limitations for outpatient.
[CUSTOMER][NEUTRAL] I'm sorry.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][POSITIVE] Perfect. And then the diagnostic ultrasounds under her primary plan, they apply it to a copay. You guys would not cover copays, correct?
[AGENT][NEUTRAL] Actually, this policy helps only with deductible, co-pay or co-insurance.
[CUSTOMER][POSITIVE] OK, perfect. And for any type of service?
[AGENT][NEUTRAL] Right, if it's, if it's done in the outpatient facility.
[CUSTOMER][NEUTRAL] Only covers copay and co-insurance if done in outpatient, OK.
[CUSTOMER][POSITIVE] Perfect. Do you think I could get a reference number for this call, please?
[AGENT][NEUTRAL] Yes ma'am, you can use my name. It's [PII] and today's date.
[CUSTOMER][POSITIVE] Awesome thank you for your help.
[AGENT][POSITIVE] You're very welcome. Is there anything else I can help you with, [PII]?
[CUSTOMER][POSITIVE] That's it. Thank you. Have a nice day.
[AGENT][POSITIVE] You have a beautiful day too and thanks for calling APL.
[AGENT][NEUTRAL] Bye bye.
[CUSTOMER][POSITIVE] Thank you.