AccountId: 011433970860
ContactId: 942da0ab-946a-4ddf-9c05-ad34f0732759
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 237210 ms
Total Talk Time (AGENT): 127808 ms
Total Talk Time (CUSTOMER): 72302 ms
Interruptions: 0
Overall Sentiment: AGENT=0.9, CUSTOMER=0.8
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/01/22/942da0ab-946a-4ddf-9c05-ad34f0732759_20250122T18:21_UTC.wav
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[AGENT][NEUTRAL] Thank you for calling APL. This is [PII]. How can I help you?
[CUSTOMER][NEUTRAL] Well, hi, [PII], this is [PII] with OU Medicine Central Insurance verification. I'm calling because I'm gonna need eligibility benefits and to see if the CPT code requires authorization, please.
[AGENT][NEUTRAL] OK, yep, I can check uh eligibility benefits and if authorization is required, uh, [PII], can I first get a good call back number from you in case we're disconnected?
[CUSTOMER][NEUTRAL] Yes, it is [PII].
[AGENT][NEUTRAL] All right, thank you. And then do you have the policy number?
[CUSTOMER][NEUTRAL] It is 00974225.
[AGENT][NEUTRAL] Alright, one moment please.
[AGENT][NEUTRAL] All right. And uh what was the name and date of birth for the insured?
[CUSTOMER][NEUTRAL] Yes, and the name on that is [PII], and date of birth is [PII].
[AGENT][NEUTRAL] Mhm.
[AGENT][NEUTRAL] Alright, thank you for verifying that, [PII]. Uh, so this policy is active. Effective date was [PII]. Well, for the for [PII], it was effective when he was born, uh, [PII], um, and this is a secondary medical policy, so it is designed to help with co-pay, deductible and co-insurance after major medical pays and where we need to look at the outpatient benefit.
[CUSTOMER][NEUTRAL] You said it's, it's for co-pay, deductibles, and what else?
[AGENT][NEUTRAL] Coinsurance, um, it's very dependent on major medical, uh, so that being said, no authorization is required as long as major medical is willing to pay this policy can.
[CUSTOMER][NEUTRAL] And coinsurance.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][POSITIVE] And what else did you need? I'm so sorry.
[AGENT][NEUTRAL] Oh no, I was just asking um uh particular benefits were you needing to check was it outpatient that we were being seen for?
[CUSTOMER][NEUTRAL] I it's, it's outpatient. It's for an echocardiogram.
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] And it's done outpatient.
[AGENT][NEUTRAL] All right.
[AGENT][NEUTRAL] Give me just a moment.
[AGENT][NEUTRAL] So their outpatient benefits, see, OK, we'll let you know verification of coverage is not a guarantee of payment for claims. So their outpatient benefit is $4000 max per occurrence, and for this plan they do have a $250 deductible that is going to be per occurrence.
[CUSTOMER][NEUTRAL] Deductible per occurrence.
[AGENT][NEUTRAL] Right.
[CUSTOMER][NEGATIVE] So basically, um, you guys are actually paying what the primary insurance doesn't pay.
[AGENT][POSITIVE] Right, that is what it's designed to help with.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] I'm sorry, I'm writing everything down.
[AGENT][NEUTRAL] No, you're fine.
[CUSTOMER][NEUTRAL] And per occurrence means each time they come in.
[AGENT][NEUTRAL] Um, yeah, so occurrence would mean, so say they broke their hand, um, and they came in and they exhausted all of the benefits for that, but they weren't done with treatment for it, um, about $4000 would go towards that occurrence of them breaking their hand, so they come in to be seen for something different, then that would be a separate occurrence.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Oh, OK. So it's per current. OK, and do you have a call reference number for me?
[AGENT][NEUTRAL] Yes.
[AGENT][NEUTRAL] Reference number would just be my first name, last initial, and today's date. Uh my name is spelled [PII] and then was there anything else I could do to help [PII]?
[CUSTOMER][POSITIVE] Oh no that was fine I appreciated it.
[AGENT][POSITIVE] Yeah, of course, thanks for calling APL. I hope you have a great rest of your day.
[CUSTOMER][POSITIVE] You too thank you bye bye.
[AGENT][POSITIVE] Thank you bye bye.