AccountId: 011433970860
ContactId: 923de6e6-6a8a-479e-a4ee-cf0b70cdc63e
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 191199 ms
Total Talk Time (AGENT): 105686 ms
Total Talk Time (CUSTOMER): 48407 ms
Interruptions: 0
Overall Sentiment: AGENT=1.3, CUSTOMER=0.2
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/02/03/923de6e6-6a8a-479e-a4ee-cf0b70cdc63e_20250203T18:48_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, ma'am.
[CUSTOMER][NEUTRAL] Um, I wanted to know the benefits for one of our patients.
[AGENT][POSITIVE] OK, well, I can help you with the benefits. May I have your name and a good contact number in case we're disconnected?
[CUSTOMER][NEUTRAL] Yes, my name is [PII].
[CUSTOMER][NEUTRAL] And the callback number is [PII].
[CUSTOMER][NEUTRAL] [PII].
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] Thank you for that and may I have the member's policy number?
[CUSTOMER][NEUTRAL] Yes, it's 186.
[CUSTOMER][NEUTRAL] 881 7.
[AGENT][NEUTRAL] Thank you, hold on one moment.
[AGENT][NEUTRAL] And can you verify the member's first and last name and date of birth?
[CUSTOMER][NEUTRAL] [PII], [PII].
[AGENT][NEUTRAL] Thank you for that and all the information provided is a verification of benefits, not a guarantee of payment. So I am showing the policy is active. It's been effective since [PII]. And what type of benefits did you want to go over today, like outpatient?
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Inpatient
[AGENT][NEUTRAL] Inpatient?
[CUSTOMER][NEUTRAL] Yes.
[AGENT][NEUTRAL] OK, so for inpatient, the policy will pay up to $2550 per person per calendar year.
[AGENT][NEUTRAL] There's no deductible.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] Did you want me to see if any of that balance has been used for the year?
[CUSTOMER][NEUTRAL] Um, yes, I wanted to know like also the co-pay for a PCP visit.
[AGENT][NEUTRAL] So this is her, this is the secondary insurance. So we don't apply a co-pay, but if primary does, we help pay that.
[CUSTOMER][NEUTRAL] Oh, OK.
[AGENT][NEUTRAL] And she
[CUSTOMER][NEUTRAL] So and as long as it's active.
[AGENT][NEUTRAL] Right, um, as long as it's active, um, and she has not used any of the benefits for this year either.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Um, any more information that comes out there? I'm not sure what else you're able to give me.
[AGENT][NEUTRAL] Um, what do you mean? Like,
[CUSTOMER][NEUTRAL] Like, you said she doesn't have any deductible, right?
[AGENT][NEUTRAL] You need to claim
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] OK. And how about the out of pocket?
[AGENT][NEUTRAL] So, OK, so like we're 2nd to, hold on one second.
[AGENT][NEUTRAL] We're second to her Blue Cross Blue Shield of Texas. So they apply like the copay deductible out of pocket. We pay towards the copay deductible and co-insurance. So once we get that, once we get the claim, um, like the out of pocket and all of that, we'll see what's been paid, um, well, what's been charged paid, and then if we need to reimburse the member or pay you as the provider.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] Because we're the secondary insurance, so we don't apply any charges to her.
[CUSTOMER][NEUTRAL] OK ma'am.
[CUSTOMER][NEUTRAL] Then that's it.
[AGENT][POSITIVE] All right, well, uh, thank you so much for calling APL and I hope you have a good day.
[CUSTOMER][POSITIVE] Thank you. Likewise.
[AGENT][POSITIVE] Thank you. Bye bye.
[CUSTOMER][NEUTRAL] Mhm bye bye.