AccountId: 011433970860
ContactId: 94d39316-8bf4-4673-bde6-dbb388e19b28
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 196479 ms
Total Talk Time (AGENT): 82405 ms
Total Talk Time (CUSTOMER): 69471 ms
Interruptions: 0
Overall Sentiment: AGENT=0.5, CUSTOMER=0.6
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/06/19/94d39316-8bf4-4673-bde6-dbb388e19b28_20250619T15:02_UTC.wav
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[AGENT][NEUTRAL] Thank you for calling APL. This is [PII]. How can I help you?
[CUSTOMER][NEUTRAL] Hi, hi [PII]. My name is [PII] calling from University of Miami. How are you doing today?
[AGENT][POSITIVE] I'm good, [PII]. How about yourself?
[CUSTOMER][NEUTRAL] Not too bad. I'm calling, uh, just to get a verification of benefits for a patient having a procedure done at our facility.
[AGENT][NEUTRAL] OK, happy to check benefits. What is the policy number?
[CUSTOMER][NEUTRAL] Uh, that's going to be 02145414, M as in Mary, L as in Larry, the number 8.
[AGENT][NEUTRAL] Thank you. And then for documentation, can I get a good callback number, please?
[CUSTOMER][NEUTRAL] Sure, that's [PII].
[AGENT][NEUTRAL] Thank you. Uh, patient name and date of birth?
[CUSTOMER][NEUTRAL] This said [PII], [PII].
[AGENT][NEUTRAL] Thank you. So patient is active. Effective date on here is [PII]. We are the members secondary insurance, so this would cover deductible, co-pay, co-insurance, the primary does not.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] All right, that's what I wanted to confirm. So deductible cover covers it. OK, perfect. And is, um, just for outpatient hospital, is there an annual maximum of coverage?
[AGENT][NEUTRAL] Mhm.
[AGENT][NEUTRAL] Looks like their outpatient benefit max for the calendar year is $3000.
[CUSTOMER][NEUTRAL] OK, are you able to confirm whether that's already been met or it's still available?
[AGENT][NEUTRAL] Let me see what they've used here one second.
[AGENT][NEUTRAL] Yeah.
[AGENT][NEUTRAL] OK. I'm gonna have to do a little math here, just a second.
[CUSTOMER][POSITIVE] Sure, sure. No, no, no worries.
[AGENT][NEUTRAL] OK
[AGENT][NEUTRAL] OK, they have 8000.
[AGENT][NEUTRAL] OK, so the remaining balance left for the year on their outpatient benefits is $3,469.86.
[CUSTOMER][NEUTRAL] And
[CUSTOMER][NEUTRAL] But she has a max of 3000?
[AGENT][NEUTRAL] No, no, no, she has, she has a calendar year max of 8000. She's used 4530.
[CUSTOMER][NEUTRAL] Oh, I, OK.
[AGENT][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] OK, that I'm, I, I heard 3000 as a maximum. That's why I was like, wait a minute, if that's way more than, OK.
[AGENT][NEUTRAL] Yeah, the
[AGENT][NEUTRAL] The the remaining balance is the 3000, sorry.
[CUSTOMER][NEUTRAL] OK, so then she'll, she has a max of 8000. She has the remaining uh $3,469 with 86 cents available.
[AGENT][NEUTRAL] Mhm, mhm.
[CUSTOMER][NEUTRAL] OK, perfect. Are you able to provide me with a reference number?
[AGENT][POSITIVE] Correct, yeah.
[AGENT][NEUTRAL] Absolutely. Call reference would be my name with today's date. My name again is [PII], which is [PII] and then my last initial is [PII].
[CUSTOMER][POSITIVE] All right, well thank you so much for that information. You have a good rest of your day.
[AGENT][NEUTRAL] You too, [PII]. Bye bye.