AccountId: 011433970860
ContactId: 9b98f394-ad9f-4414-baa9-e0d851656e54
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 266220 ms
Total Talk Time (AGENT): 125853 ms
Total Talk Time (CUSTOMER): 99224 ms
Interruptions: 0
Overall Sentiment: AGENT=1.9, CUSTOMER=1
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/03/20/9b98f394-ad9f-4414-baa9-e0d851656e54_20250320T14:31_UTC.wav
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[AGENT][POSITIVE] Good morning. Thank you for calling APL. My name is [PII]. How may I help you?
[CUSTOMER][NEUTRAL] Hi [PII], my name is [PII]. I'm calling as part of Texas Health. I'm reaching out because there's a patient coming into our facility today for a diagnostic imaging, and they had provided this APL policy as an additional coverage and asked that we try to obtain benefits for the billing.
[AGENT][POSITIVE] I can help you with that. Yeah, it'd be my pleasure. And I'm sorry, I missed your name. It's kinda hard to hear you. What's your name?
[CUSTOMER][NEUTRAL] I'm hoping maybe you could help me.
[CUSTOMER][NEUTRAL] My name is [PII].
[AGENT][NEUTRAL] [PII], thank you. And a callback number?
[CUSTOMER][NEUTRAL] Sorry, my direct phone number is [PII].
[CUSTOMER][NEUTRAL] [PII].
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] Thank you, [PII]. And what is the policy number for the patient?
[CUSTOMER][NEUTRAL] The policy given is 02.
[CUSTOMER][NEUTRAL] 58
[CUSTOMER][NEUTRAL] 684 1
[AGENT][NEUTRAL] Thank you, [PII]. And what is the patient's name and date of birth, please, ma'am?
[CUSTOMER][NEUTRAL] Patient's name is [PII]. Last name [PII]. Date of birth [PII].
[AGENT][POSITIVE] All right, thank you. And I can help you with those benefits for [PII].
[AGENT][NEUTRAL] I'm showing her policy is active. Effective date is [PII]. This is a secondary policy to her major medical.
[AGENT][NEUTRAL] And you said she's coming in for diagnostic testing?
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Yes, ma'am.
[AGENT][NEUTRAL] And will that be in an office setting or in an outpatient facility?
[CUSTOMER][NEUTRAL] Outpatient facility.
[AGENT][POSITIVE] Thank you.
[AGENT][NEUTRAL] Let's see, [PII], she does have outpatient coverage.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] Um, her policy.
[AGENT][POSITIVE] Let me get that pulled up. I apologize. I'm trying to get that pulled up for you.
[CUSTOMER][POSITIVE] That's OK, take your time.
[AGENT][POSITIVE] Thank you. I appreciate it.
[AGENT][NEUTRAL] So her policy covers.
[CUSTOMER][NEUTRAL] Of course.
[AGENT][NEUTRAL] $2100 per calendar year.
[AGENT][NEUTRAL] And that is for inpatient and outpatient benefits combined.
[AGENT][NEUTRAL] And that does cover diagnostic testing.
[CUSTOMER][NEUTRAL] Has she utilize any of it yet?
[AGENT][NEUTRAL] She has not used any of that as of right now. And I'm checking one other thing. Let me check one other thing for you.
[AGENT][NEUTRAL] Looks like there may be a deductible on this policy. I wanted to check that.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] There is a $1000 deductible on this plan per calendar year, and she has not met any of that deductible either.
[CUSTOMER][NEUTRAL] Mm.
[CUSTOMER][NEUTRAL] So would she have to meet a portion of the deductible before the plan would pay up to 2100 for inpatient and or outpatient services?
[AGENT][NEUTRAL] The
[AGENT][POSITIVE] That is correct.
[CUSTOMER][NEUTRAL] OK, and 0 use. Alright, um, is this policy, it sounds like it's a type of indemnity plan. Would it be associated that we have to worry about a network status or authorization for services?
[AGENT][NEUTRAL] This is a secondary gap policy. Authorization is not required and no network.
[CUSTOMER][NEUTRAL] Ah, there it is.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Alright, gap plan no and it will bill secondary to her major medicine, all right.
[CUSTOMER][POSITIVE] Well that made it easy. May you, could you please spell your name for me?
[AGENT][NEUTRAL] Absolutely. My name is [PII], I'm sorry, [PII] my last [PII] is [PII], I do know how to spell my name. It just didn't come out right.
[CUSTOMER][NEUTRAL] Hey.
[CUSTOMER][POSITIVE] Fantastic.
[CUSTOMER][NEUTRAL] It's early. Um, if you need my, my last initial is [PII], do we have a reference number?
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] It's gonna be my name in today's date.
[CUSTOMER][POSITIVE] Fantastic. Thank you so much for your time.
[AGENT][POSITIVE] My pleasure to assist you today, [PII]. Thank you for calling APL and I hope you have a wonderful day.
[CUSTOMER][POSITIVE] Oh you too thank you bye bye.
[AGENT][POSITIVE] Thank you. Bye-bye.