AccountId: 011433970860
ContactId: 9a79c237-ded8-4da2-ab53-b9f803b57727
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 326450 ms
Total Talk Time (AGENT): 153408 ms
Total Talk Time (CUSTOMER): 99924 ms
Interruptions: 1
Overall Sentiment: AGENT=1, CUSTOMER=0.5
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/04/11/9a79c237-ded8-4da2-ab53-b9f803b57727_20250411T13:12_UTC.wav
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[AGENT][POSITIVE] Good morning. Thank you for calling APO. This is. How may I assist you?
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Hello, I was calling to see, um, I'm, I'm calling for a provider line and I was just trying to understand like, uh, the benefit coverage um I have a patient she's using her insurance and she was trying to use this and from my understanding this is not this is not like an insurance this is I, I'm just trying to see how should I bill her.
[AGENT][NEUTRAL] OK. I can check and see what type of policy she has with us. Um, may I have your name and a callback number just in case we get disconnected?
[CUSTOMER][NEUTRAL] With this coverage.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] [PII], uh, and the callback number is [PII].
[AGENT][NEUTRAL] Thank you. And may I have the name of the facility you're calling from?
[CUSTOMER][NEUTRAL] CD urgent care.
[AGENT][NEUTRAL] OK. And may I have the patient's policy number?
[AGENT][NEUTRAL] OK
[CUSTOMER][NEUTRAL] Yes, uh, 025867887.
[AGENT][NEUTRAL] Thank you. What's the name and date of birth of the patient?
[CUSTOMER][NEUTRAL] Name is [PII]. Date of birth is [PII].
[CUSTOMER][NEUTRAL] [PII], uh, do you want me to spell it?
[AGENT][POSITIVE] OK, perfect.
[AGENT][NEUTRAL] No, no, no, it's fine. I got it. Thank you. All right. uh, let's see, let me check the benefits on this, and this is not a guarantee of payment, just a verification of coverage, and that's just a disclaimer. This is one of our secondary supplemental plan to the major medical. So this plan is set up to help with the deductibles, co-payment, and co-insurance from the major medical. So this is a secondary supplemental.
[CUSTOMER][NEUTRAL] OK
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][POSITIVE] And um with this one, let's yeah.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] There is a deductible. There's a calendar year deductible of 1000.
[AGENT][NEUTRAL] And then after that deductible, there is a maximum benefit that we cover outpatient. Let me see here.
[CUSTOMER][NEUTRAL] But she doesn't have a deductible on her plan. She just has an out of pocket.
[AGENT][NEUTRAL] For which one? For her major medical or for this one?
[CUSTOMER][NEUTRAL] Her major in medical.
[AGENT][NEUTRAL] Yeah, for her major medical, she doesn't, but she has a deductible on this one. So there's a deductible of 1000 on this one.
[AGENT][NEUTRAL] And then after that 1000, uh, we cover up to 2100 per year for outpatient services.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][MIXED] OK, but she has to cover 1001st.
[AGENT][NEUTRAL] Mhm, yes.
[CUSTOMER][NEUTRAL] OK, and so.
[CUSTOMER][NEUTRAL] Right now, uh, are you able to pull up her plan to see because all I see, I see, oh, OK, you have it up, so she, so for today's visit she'll be paying her uh co-pay.
[AGENT][NEUTRAL] Mhm.
[AGENT][NEUTRAL] I believe so. Let me double check. Uh, let me check the history and see how much she has made out of that deductible. OK, one moment.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][POSITIVE] OK, thank you.
[AGENT][POSITIVE] You're welcome.
[CUSTOMER][NEUTRAL] Hi.
[AGENT][NEUTRAL] All right, here it is. Let's see.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] She has not met or used her benefits for this year. So yeah, she still has that $1000 deductible. So, yes, she needs to pay out of pocket today.
[CUSTOMER][NEUTRAL] OK
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][POSITIVE] All right perfect thank you so much uh can I get a reference?
[AGENT][NEUTRAL] Mhm.
[AGENT][NEUTRAL] Um, we don't have reference numbers. You can use my name in today's date if you would like, Ms. [PII]. Um, now, if you need to send a claim so that can count against that deductible, that would be great, um, even though she pay out of pocket, so, you know, it will be part of that deductible.
[CUSTOMER][NEUTRAL] Oh
[CUSTOMER][NEUTRAL] OK, yes, I'll add that so the billing team will know, um, and what's your name so I can have a rep like a a form of a reference so they'll know I talked to someone.
[AGENT][NEUTRAL] Mhm.
[AGENT][NEUTRAL] Sure. Yes. No problem. It's OK. My name is [PII]. That's [PII].
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][POSITIVE] OK, perfect, thank you.
[AGENT][POSITIVE] OK. You're welcome. Is there anything else I may help you with today?
[AGENT][NEUTRAL] Yeah
[CUSTOMER][NEUTRAL] No, that'll be it.
[AGENT][POSITIVE] OK, well thank you for calling APL. Have a good day.
[CUSTOMER][NEUTRAL] You too bye.