AccountId: 011433970860
ContactId: 994df65f-3150-41f0-aa87-8a26b9a127c5
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 311339 ms
Total Talk Time (AGENT): 162659 ms
Total Talk Time (CUSTOMER): 91653 ms
Interruptions: 0
Overall Sentiment: AGENT=0.4, CUSTOMER=0.5
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/01/16/994df65f-3150-41f0-aa87-8a26b9a127c5_20250116T17:21_UTC.wav
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[AGENT][NEUTRAL] Thank you for calling APL. This is [PII]. How may I help you?
[CUSTOMER][NEUTRAL] Hi, I'm trying to verify that patient's insurance.
[AGENT][NEUTRAL] OK, I can help you with the patient's insurance. Uh, can you please give me your name and your callback number please?
[CUSTOMER][NEUTRAL] Yeah, my name is [PII]. My callback number is [PII].
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] OK, [PII], what is the patient's name?
[CUSTOMER][NEUTRAL] Patient's name is [PII].
[AGENT][NEUTRAL] And what's [PII]
[CUSTOMER][NEUTRAL] And what was your name again? I'm sorry.
[AGENT][NEUTRAL] My name is [PII]
[CUSTOMER][NEUTRAL] Sorry.
[AGENT][NEUTRAL] Yes, sir. And then what is [PII]'s date of birth?
[CUSTOMER][POSITIVE] OK, thank you to me.
[CUSTOMER][NEUTRAL] Her date of birth is [PII].
[AGENT][NEUTRAL] And the policy number, please?
[CUSTOMER][NEUTRAL] 02552722
[AGENT][NEUTRAL] OK, let me pull in that policy real quick.
[AGENT][NEUTRAL] OK, I've got the policy pulled up. Um, did you need eligibility or benefits? How can I help you with it?
[CUSTOMER][NEUTRAL] Yes, I need, I need um eligibility benefits.
[AGENT][NEUTRAL] OK, I can get both of those for you, eligibility and benefits. Um, [PII] does have an active policy. Her effective date is [PII].
[AGENT][NEUTRAL] And this is just to verify her coverage. It's not a guarantee of payment. She has a supplemental insurance policy that is secondary to the primary. It's a gap policy that helps with deductible, co-pay and co-insurance.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] Excuse me, um, she has an inpatient benefit amount of $2550 per calendar year.
[AGENT][NEUTRAL] And then she has an outpatient calendar year benefit of $2550 also.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK, so how does this, you said it helps with the deductible car insurance or anything like that? And it's, you said 2500, right?
[AGENT][NEUTRAL] Right.
[AGENT][NEUTRAL] Right.
[CUSTOMER][NEUTRAL] For the outpatient.
[AGENT][POSITIVE] Yes, that's correct.
[CUSTOMER][NEUTRAL] Has she met any of that?
[AGENT][NEUTRAL] Let me, let me check for you real quick.
[AGENT][NEGATIVE] Nothing has been used for the year of [PII].
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] So if she has on her primary insurance, she doesn't have a co-insurance, she doesn't have a uh co-payment, she has a deductible of $5000.
[CUSTOMER][NEUTRAL] How, what benefits is it gonna help her on that side?
[AGENT][POSITIVE] Right. It would help with, um with the deductible or the co-pay or co-insurance. It, either or, it's not like she doesn't have to have all three of them for it to help. It'll help with one of those three.
[AGENT][NEUTRAL] And then
[CUSTOMER][NEUTRAL] And how so, so.
[AGENT][NEUTRAL] So, uh, it goes by what the primary insurance bills. So when the claim is sent in, the primary insurance EOB needs to be sent in with the claim, and depending on what was paid for the primary insurance is what APO will pay for the deductible co-pay or co-insurance. But she has that amount up.
[CUSTOMER][NEUTRAL] Got you, so they're gonna cover it after that you.
[AGENT][NEUTRAL] Right, right. Yes.
[CUSTOMER][POSITIVE] Got you.
[CUSTOMER][NEUTRAL] So she's having an endoscopy.
[CUSTOMER][NEUTRAL] Um, and she's having a colonoscopy, but our colonoscopy is a pretty, and I know her primary insurance covers that at 100%, but her endoscopy, they, she normally pays a percentage of her endoscopy. So I just want to confirm those things with you as well.
[AGENT][NEUTRAL] OK. Uh, let me look and see. I'll have to pull her policy in. Uh, she, what kind of, um, facility is she having it done in?
[CUSTOMER][NEUTRAL] It's an ambulatory surgery center so it's outpatient.
[AGENT][NEUTRAL] OK, so the ambulatory surgery center is actually um on her outpatient benefit. She can go to an ER urgent care center, MRI imaging center, or an ambulatory center.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] But then
[CUSTOMER][NEUTRAL] OK, I see now I, now after talking to you, I do know her patient responsibility. Can I get a reference number?
[AGENT][NEUTRAL] Yes, you can use my name. It's [PII] and today's date.
[CUSTOMER][NEUTRAL] OK, do you have a last name initial?
[AGENT][NEUTRAL] Yes, it's [PII]
[CUSTOMER][POSITIVE] OK, thank you so much and you have a good day, OK?
[AGENT][POSITIVE] You have a great day too, [PII] thanks for calling APL.
[CUSTOMER][NEUTRAL] Bye.