AccountId: 011433970860
ContactId: 988f5e83-59a3-4198-a4ae-5f34f56419cc
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 275709 ms
Total Talk Time (AGENT): 126525 ms
Total Talk Time (CUSTOMER): 98886 ms
Interruptions: 1
Overall Sentiment: AGENT=0.5, CUSTOMER=0.2
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/05/27/988f5e83-59a3-4198-a4ae-5f34f56419cc_20250527T18:55_UTC.wav
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[AGENT][NEUTRAL] Thank you for calling APL. This is [PII]. How can I help you?
[CUSTOMER][NEUTRAL] Good afternoon. We're calling from Doctor [PII]'s cardiovascular clinic, a provider of cardiovas.
[CUSTOMER][NEUTRAL] Um, we were just wondering if um.
[CUSTOMER][NEUTRAL] The benefits and and eligibility and if the patient has a deductible.
[AGENT][POSITIVE] Sure I can help you with that. Can I get your name and a good call back number in case we get disconnected?
[CUSTOMER][NEUTRAL] Mhm
[CUSTOMER][NEUTRAL] [PII] and a good call back number would be the one I'm calling from, which is area code [PII]. I'm sorry, [PII]. I'm so sorry about that.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] And do you have the policy number?
[CUSTOMER][NEUTRAL] The policy number I have for patient is gonna be 023375-48.
[AGENT][NEUTRAL] OK, let me check.
[AGENT][NEUTRAL] Just a moment.
[CUSTOMER][NEUTRAL] Mhm
[AGENT][NEUTRAL] And can I get the patient's name and date of birth?
[CUSTOMER][NEUTRAL] The name I have is [PII] with the date of birth of [PII].
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] And you're winning eligibility?
[CUSTOMER][POSITIVE] And benefits mhm.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] It looks like, oh, give me a moment.
[CUSTOMER][NEUTRAL] You didn't
[CUSTOMER][NEUTRAL] Um
[AGENT][NEUTRAL] This policy is active with an effective date of [PII].
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] This is a secondary gap insurance that helps pay for co-pay, co-deductible, and co-insurance.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][POSITIVE] And let me get to the benefits.
[AGENT][NEUTRAL] And this is just a verification of benefits and not a guarantee of payment?
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] I am showing that she has um an inpatient benefit maximum of up to $2550 per calendar year.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] With a $0 deductible, there's a $0 deductible, mhm.
[CUSTOMER][NEUTRAL] So she does have a deductible. I'm sorry?
[CUSTOMER][NEUTRAL] 0 $0 deductible.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] Um, as long as it's for an accident or illness.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] And she has an outpatient benefit maximum of the same amount up to $2550 per calendar year. Again, that's with a $0 deductible as long as it's for an accident or a sickness.
[CUSTOMER][NEUTRAL] Mhm
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] Let me see.
[CUSTOMER][NEUTRAL] I
[AGENT][NEUTRAL] I am showing that she has an outpatient emergency room deductible for an accident or sickness for occurrence of $0 so she doesn't have a deductible for an emergency room.
[CUSTOMER][NEUTRAL] Mhm
[CUSTOMER][NEUTRAL] OK, so then just to confirm one.
[AGENT][NEUTRAL] And was there anything else specifically?
[CUSTOMER][NEUTRAL] No, no, it was just to confirm that uh the insurance is the one that's gonna be covering the primary one, correct?
[AGENT][NEUTRAL] Mhm.
[AGENT][NEUTRAL] So primary will be, will need to be billed first and then we will need the primary EOB in this claim um to show that benefits were paid through the primary insurance and then this policy will help pick up.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] OK, because in her prime it is showing that she does have copay, so we don't charge the patient, uh, because we'll be billing it to the insured the primary first, correct?
[AGENT][NEUTRAL] Right, and then we should help with the copay.
[CUSTOMER][NEUTRAL] OK perfect so we'll go ahead and uh uh pass patient through with 0.
[AGENT][NEUTRAL] OK, is there anything else I can help you with? Did you need the fax number for the claim?
[CUSTOMER][NEUTRAL] Not at all, ma'am.
[CUSTOMER][NEUTRAL] Uh, yes, please.
[AGENT][NEUTRAL] OK, it'll be attention claims department. The fax number is [PII].
[CUSTOMER][NEUTRAL] Uh huh.
[AGENT][NEUTRAL] [PII].
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] [PII].
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][POSITIVE] You got it thank you so much for that verification, ma'am.
[AGENT][POSITIVE] Alright, thank you for calling APL and have a great day.
[CUSTOMER][NEUTRAL] Likewise bye bye.
[AGENT][NEUTRAL] Bye.