AccountId: 011433970860
ContactId: 92ec974e-ea4b-4e52-8a46-aa2ac42549d3
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 239169 ms
Total Talk Time (AGENT): 99491 ms
Total Talk Time (CUSTOMER): 104256 ms
Interruptions: 0
Overall Sentiment: AGENT=0.3, CUSTOMER=0.2
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/02/19/92ec974e-ea4b-4e52-8a46-aa2ac42549d3_20250219T14:24_UTC.wav
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[AGENT][NEUTRAL] Thank you for calling APL. This is [PII]. How can I help you?
[CUSTOMER][NEUTRAL] Hi, this is [PII] calling from AdventHealth. I would like to verify medical outpatient benefit for this patient.
[AGENT][POSITIVE] Um, yes, ma'am. I can assist you with benefits. Um, first, could I get your name again and a good callback number in case we're disconnected?
[CUSTOMER][NEUTRAL] [PII]
[CUSTOMER][NEUTRAL] And my first name is [PII]
[AGENT][NEUTRAL] Thank you. Now, can I get the policy number, please?
[CUSTOMER][NEUTRAL] Policy number is 02473012 MLH.
[AGENT][NEUTRAL] Please verify the patient's name and date of birth.
[CUSTOMER][NEUTRAL] Patient's name is [PII].
[CUSTOMER][NEUTRAL] Date of birth [PII].
[AGENT][NEUTRAL] And just let me advise you that verification of coverage does not guarantee payment of claims. Um, the effective date on this policy was [PII]. The policy is still active.
[AGENT][NEUTRAL] And this is for outpatient benefits?
[CUSTOMER][NEUTRAL] Uh, yes, ma'am. Um, is there any coordination of benefit with the Blue Cross with this plan?
[CUSTOMER][NEUTRAL] Patient has primary insurance Blue Cross. Is this a Medicare supplement plan?
[AGENT][NEUTRAL] Uh,
[AGENT][NEUTRAL] Um, this is a secondary gap insurance plan, and we do coordinate with Blue Cross Blue Shield for covered services, um, based on the place of service. There's coverage for outpatient hospital facilities, inpatient hospital facilities, DME, but there's no coverage for office visits unless it's for a cancer treatment.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK, so, um, do you cover Blue Cross, uh, deductible from Blue Cross Blue Shield or?
[AGENT][NEUTRAL] Um, yes, it is what.
[CUSTOMER][NEUTRAL] Just the coinsurance.
[AGENT][NEUTRAL] Yes, what type, what place of service is this for?
[CUSTOMER][NEUTRAL] It's for uh uh hospital outpatient service. Patient has uh echocardiogram.
[AGENT][NEUTRAL] Um,
[AGENT][NEUTRAL] OK. Yes, ma'am. We'll cover up to $300 per day and that's for the co-pay, the co-insurance, and the deductible after the primary insurance processes the claim.
[CUSTOMER][NEUTRAL] So, OK. Um, hold on. This is kind of a different type of plan, so I'm just trying to understand. So you cover $300 per day from the primary insurance, right?
[AGENT][NEUTRAL] Right. The primary insurance will process the claim first and the charges that go towards the copay, the co-insurance, and the deductible, we will cover that up to 300 per day.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] OK. OK. Thank you. Um, thanks for letting me know about this and the cover co-insurance after the.
[CUSTOMER][NEUTRAL] Processed claim. OK. um.
[CUSTOMER][NEUTRAL] OK
[CUSTOMER][NEUTRAL] May I have your name and reference number, please?
[AGENT][NEUTRAL] Yes, for the reference number, you can use my name and today's date. My name is [PII]. Um it's spelled [PII] My last initial is [PII] and today's date. Um, is there anything else that I can assist you with?
[CUSTOMER][NEUTRAL] It's [PII] is your first name, right?
[AGENT][NEUTRAL] Yes, ma'am.
[CUSTOMER][POSITIVE] OK, thank you so much, Ay, uh, you have a wonderful day.
[AGENT][NEUTRAL] You do the same, [PII]. Thank you for calling APL. Mm bye.
[CUSTOMER][NEUTRAL] Mhm bye bye.