AccountId: 011433970860
ContactId: 97c9b08b-cd39-4115-baf7-040e1d37d6e0
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 159059 ms
Total Talk Time (AGENT): 97664 ms
Total Talk Time (CUSTOMER): 55355 ms
Interruptions: 0
Overall Sentiment: AGENT=0.3, CUSTOMER=0.9
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/02/03/97c9b08b-cd39-4115-baf7-040e1d37d6e0_20250203T22:31_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], and I'm calling from Yuma Regional Medical Center to get benefits for a patient and check for prior off.
[AGENT][NEUTRAL] Yeah, I can check benefits for you and see if authorization is required. Um, [PII], can I get a good call back number from you first in case we're disconnected?
[CUSTOMER][NEUTRAL] Sure, it's [PII] direct line.
[AGENT][NEUTRAL] Alright, thank you. And then do you have the policy number?
[CUSTOMER][NEUTRAL] Yes, it's 01605731.
[AGENT][NEUTRAL] Thank you. And uh what was the name and date of birth for the insured?
[CUSTOMER][NEUTRAL] It's [PII] and the date of birth is [PII].
[AGENT][NEUTRAL] Perfect, thank you for verifying that [PII]. Oh, so this policy is active. Effective date was [PII], and so this is a secondary medical policy. It is designed to help with co-pay, deductible and co-insurance after major medical pays. Uh, this plan is very dependent on major medical as long as they're willing to pay this policy can, uh, if they don't, this policy can't, so no authorization is required as long as you know, the major medical is willing to pay.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] OK, OK, so no as required. OK, and the benefits, how would it work then? Would they just
[AGENT][NEUTRAL] Right.
[AGENT][NEUTRAL] Um, is this for outpatient?
[CUSTOMER][NEUTRAL] Yes, it's for outpatient hospital surgery.
[AGENT][NEUTRAL] OK, got you, alrighty and so of course I will let you know verification of coverage is not a guarantee of payment for claims, but again, as long as their major medical is contributing to that, all we would need is that uh EOB from them and we can pay a benefit. The outpatient benefit is $2500 per calendar year.
[CUSTOMER][NEUTRAL] Hm.
[AGENT][NEUTRAL] And if you'll give me one moment, I will see if any of that has been used.
[CUSTOMER][POSITIVE] OK, thank you.
[AGENT][NEUTRAL] OK, none has been used so far this year.
[CUSTOMER][NEUTRAL] OK, so whatever the other benefits for the primary one, are this secondary insurance would cover up to 2500.
[AGENT][NEUTRAL] Mhm.
[AGENT][NEUTRAL] Correct, per calendar year it's that amount, um, deductible, co-pay or co-insurance.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][POSITIVE] OK, alright, perfect, thank you very much. Do you use your call reference number?
[AGENT][NEUTRAL] Of course.
[AGENT][NEUTRAL] Yes, it would just be uh my first name, last initial, and today's date. Uh so my name is spelled [PII] Last initial is [PII], was there anything else I could help you with, [PII]?
[CUSTOMER][NEUTRAL] OK
[CUSTOMER][POSITIVE] That will be all, thank you very much.
[AGENT][POSITIVE] Alright, yeah, thanks for calling APL. Have a great rest of your day.
[CUSTOMER][NEUTRAL] You too bye bye.
[AGENT][NEUTRAL] Bye bye.