AccountId: 011433970860
ContactId: 8f58d898-4f5f-4f68-994e-ebc5c14032dc
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 211880 ms
Total Talk Time (AGENT): 135490 ms
Total Talk Time (CUSTOMER): 59931 ms
Interruptions: 0
Overall Sentiment: AGENT=0.8, CUSTOMER=0.3
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/01/16/8f58d898-4f5f-4f68-994e-ebc5c14032dc_20250116T20:13_UTC.wav
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[AGENT][NEUTRAL] Good afternoon. Thank you for calling APL. This is [PII]. How may I help you today?
[CUSTOMER][NEUTRAL] Uh yes, I'm calling to get benefits on one of your members, uh, to see if you cover her deductible.
[AGENT][POSITIVE] I'd be glad to help you. Can you give me a good policy number and your name, please?
[CUSTOMER][NEUTRAL] My name is [PII] You said your name was [PII]. What's the first letter to your last name?
[AGENT][NEUTRAL] Uh, [PII], my first initial is [PII]
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK, this card she gave us, it only has a group number.
[AGENT][NEUTRAL] Should say a certificate number on there somewhere.
[CUSTOMER][NEUTRAL] Oh
[CUSTOMER][NEUTRAL] Nope, it doesn't say a certificate number.
[AGENT][NEUTRAL] Hm.
[CUSTOMER][NEUTRAL] On the card it has outer number 02103258ML8.
[AGENT][POSITIVE] That's right, that is exactly what I need. All right. Thank you for that, [PII]. Now while I'm pulling this up, go ahead and give me a good return telephone call number just in case we're disconnected, please, ma'am.
[CUSTOMER][NEUTRAL] [PII]
[AGENT][NEUTRAL] Alrighty, [PII], thank you for all that information and what is your patient's name and date of birth?
[CUSTOMER][NEUTRAL] [PII] [PII].
[AGENT][NEUTRAL] Alright, [PII], thanks for that information. Looks like [PII] is the dependent I mean is the insured on this medical supplemental plan. I do show her original effective date is [PII]. She is current and active, but I must advise that verification of coverage is not a guarantee of payment on a claim, but you did say you want some type of benefit. Is that correct? Excuse me.
[CUSTOMER][NEUTRAL] Correct, she's here for an MRI and she has a deductible with her primary insurance $295.07. So I'm calling to see if you guys cover that.
[AGENT][NEUTRAL] Oh
[AGENT][NEUTRAL] Oh.
[AGENT][NEUTRAL] Alright, let me get her outpatient benefit pack pulled up. Now, of course, what we are is her medical supplemental plan. So what we would uh pick up and pay on is anything for sickness and injury that is supplied towards your deductible, co-pay or co-insurance and her primary insurance carrier. Now her outpatient benefit here is no pre-cert, no deductible, and she has a $1500 outpatient benefit payable here per calendar year.
[CUSTOMER][NEUTRAL] OK, so do you pick up the 29507?
[AGENT][NEUTRAL] As long as she hadn't already met the $1500 benefit.
[CUSTOMER][NEUTRAL] Can you check to see if she's met it?
[AGENT][NEUTRAL] That is
[AGENT][NEUTRAL] Let's see if we have any claims. Of course it's only gonna be as of today anyway, but yeah, we don't have any claims paid for her uh for this year at all yet.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] So she's fine.
[AGENT][NEUTRAL] Yes ma'am, but of course I cannot guarantee that benefit because it depends on which, you know, claim comes in here first and she makes that max. But as long as she's not met the max, then yes ma'am, it is something that would be payable as long as it is applied towards your deductible copay or co-insurance.
[CUSTOMER][NEUTRAL] OK, uh, what's the reference number for this call?
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] We do not give breakfast somewhere, [PII], but you can use my name today that if you need to do so, OK? Is that all I can help you with?
[CUSTOMER][NEUTRAL] And
[CUSTOMER][NEUTRAL] OK, what time zone are you in?
[AGENT][NEUTRAL] Uh, it is 2:15 here.
[CUSTOMER][NEUTRAL] 2:15 Central Standard.
[AGENT][NEUTRAL] Yes, ma'am. Yes ma'am.
[CUSTOMER][POSITIVE] OK, thank you.
[AGENT][POSITIVE] Yes, ma'am. Thank you for calling APL Beverly. You have a great day.
[CUSTOMER][NEUTRAL] You too.