AccountId: 011433970860
ContactId: 8ec586c8-f68e-4681-a751-62aa5ee8329d
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 325579 ms
Total Talk Time (AGENT): 123628 ms
Total Talk Time (CUSTOMER): 101591 ms
Interruptions: 3
Overall Sentiment: AGENT=0.9, CUSTOMER=0.2
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/01/30/8ec586c8-f68e-4681-a751-62aa5ee8329d_20250130T19:17_UTC.wav
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[AGENT][POSITIVE] Good afternoon. Thank you for calling APL. My name is [PII]. How may I help you?
[CUSTOMER][NEUTRAL] Hello, [PII]. I was speaking to somebody on a patient and they hung up the call.
[AGENT][NEUTRAL] They hung up the call?
[AGENT][NEUTRAL] Or the call dropped.
[CUSTOMER][NEUTRAL] Yes, ma'am.
[CUSTOMER][NEUTRAL] No, well, I told her that if she could please hold and the call was disconnected when I came back, came back.
[AGENT][POSITIVE] OK, well, I can definitely help you and look into that for you. OK. May I have your name and a good contact number in case we're disconnected?
[CUSTOMER][NEUTRAL] So I don't know what way.
[CUSTOMER][NEUTRAL] [PII], last name initial is [PII].
[AGENT][NEUTRAL] OK, [PII], may I have a good contact number in case we're disconnected and then the policy number?
[CUSTOMER][NEUTRAL] [PII]
[AGENT][NEUTRAL] And the policy number whenever you're ready.
[CUSTOMER][NEUTRAL] Policy number 02.
[CUSTOMER][NEUTRAL] 035308ML8
[AGENT][POSITIVE] Thank you. Hold on one moment.
[AGENT][NEUTRAL] Who is this? Hold on one second.
[AGENT][NEUTRAL] And can you verify that, well, actually you don't have to verify. I see the notes um here. And so what was happening, it looks like you were calling for outpatient benefits and eligibility.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Yes, so I, we, we, we usually run to the primary if they have not met their, their deductible usually, um, secondary does not pick up.
[AGENT][NEUTRAL] Wait, I'm sorry, it's hard to hear you.
[AGENT][NEGATIVE] It's, it's hard to hear. It's like staticky.
[CUSTOMER][NEUTRAL] So usually when the patient has
[CUSTOMER][NEUTRAL] Can you hear me now?
[AGENT][NEUTRAL] Yes, I can hear you now.
[CUSTOMER][NEUTRAL] So usually I was letting the lady know that when a patient has a deductible, the secondary don't usually pick up after the primary. Um, I let her know that the patient has a $6000 deductible with her primary that she has not met, but she was informing me that y'all still pick up even though they have not met the deductible, and I just needed to make sure that that information was correct.
[AGENT][NEUTRAL] All right, so all the information provided is a verification of benefits, not a guarantee of payment. Um, so, let me see.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] OK, so there's a $6000 deductible for, yes, we will still pick up because the, the secondary policy we pay towards the copay, the deductible and co-insurance. So you would be primary, um, they would apply if the if the insured is um responsible for paying that deductible before services are done, then they could be reimbursed on the back end once we receive that claim, but yes, we pay towards the copay, deductible and co-insurance.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK, uh, so I just needed to make sure that I have information cause just if anything comes back towards us, I need to have documentation on this. So do you have a last name initial you could give me?
[AGENT][NEUTRAL] Mhm.
[AGENT][NEUTRAL] Right, I understand.
[AGENT][NEUTRAL] Yes, it's [PII].
[CUSTOMER][NEUTRAL] OK, and then I don't know if y'all go based on plans or something.
[AGENT][NEUTRAL] And being um keep go ahead.
[AGENT][NEUTRAL] Yeah, I was trying to say, so the outpatient um max for the calendar year for this policy is $6600. So we would apply up to that amount and that's for the whole year. Did you want me to see if she's used any?
[CUSTOMER][NEUTRAL] OK, ma'am.
[CUSTOMER][NEUTRAL] Uh, yeah, you can check that.
[AGENT][NEUTRAL] OK, hold on one second.
[AGENT][NEUTRAL] Alright, so she hasn't used any of the benefits for [PII], so she still has that balance to use for outpatient benefits.
[CUSTOMER][NEUTRAL] OK, um,
[CUSTOMER][NEUTRAL] And do you have a reference number for the call?
[AGENT][NEUTRAL] So there's no call reference number, but you can use my name, which is [PII], first initial to my last name is [PII], and then today's date.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] See
[AGENT][NEUTRAL] Alright, [PII], is there anything else I could assist you with today?
[CUSTOMER][NEUTRAL] No, hold on, give me one second.
[AGENT][NEUTRAL] Sure.
[CUSTOMER][NEUTRAL] OK, that's it.
[AGENT][POSITIVE] Alright, well, thank you so much for calling APL and I hope you have a great day.
[CUSTOMER][POSITIVE] Thank you.
[AGENT][POSITIVE] You're welcome