AccountId: 011433970860
ContactId: 9c2bc181-c62f-42ab-93b6-14b118ed489b
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 206880 ms
Total Talk Time (AGENT): 65774 ms
Total Talk Time (CUSTOMER): 120840 ms
Interruptions: 6
Overall Sentiment: AGENT=1.1, CUSTOMER=0.5
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/04/15/9c2bc181-c62f-42ab-93b6-14b118ed489b_20250415T19:17_UTC.wav
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[CUSTOMER][NEUTRAL] Good afternoon, [PII]. My name is [PII]. I'm calling from a provider's office. I'm calling because I need to verify benefits for um a patient that's coming in, please.
[AGENT][POSITIVE] Thanks for calling APL. This is [PII]. How can I help you?
[AGENT][NEUTRAL] OK. Do you have a good callback number, [PII]?
[CUSTOMER][POSITIVE] Thank you
[CUSTOMER][NEUTRAL] Yes, it's [PII].
[AGENT][NEUTRAL] OK, thank you. Do you have the policy number of the patient?
[CUSTOMER][NEUTRAL] Yes, it is 02419300.
[CUSTOMER][NEUTRAL] Right, I'm gonna put um I'm [PII], uh, date of birth [PII].
[AGENT][NEUTRAL] And patient name and date of birth?
[CUSTOMER][NEUTRAL] yet, but your insurance won't cover it so that he.
[AGENT][NEUTRAL] OK, thank you. And let's see, policies effective [PII], it's active. Is this gonna be for outpatient benefits?
[CUSTOMER][POSITIVE] It um hold it properly.
[CUSTOMER][NEUTRAL] Yes, uh, for a specialist.
[AGENT][NEUTRAL] Um
[CUSTOMER][NEUTRAL] So I do see that this member has um uh primary insurance with oh [PII] I clicked out of it uh with UMR unit Healthcare um so this would be her um secondary correct or gap.
[AGENT][NEUTRAL] Yes, it is, um.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] So after the primary processes, this could potentially pick up co-pay, deductible or co-insurance. Um, so for this, let's see.
[CUSTOMER][NEUTRAL] After the primary processes this could potentially pick up copay.
[AGENT][NEUTRAL] Yeah
[AGENT][NEUTRAL] Looks like they have a $500 per occurrence benefit.
[CUSTOMER][NEUTRAL] Like they have a $500 per current.
[CUSTOMER][NEUTRAL] I'm so sorry, what was that again? $500 what?
[AGENT][NEUTRAL] That's per occurrence, so it would be like for a particular like diagnosis in a ninety-day period.
[CUSTOMER][NEUTRAL] That's for
[CUSTOMER][NEUTRAL] It would be like
[CUSTOMER][NEUTRAL] Oh, OK.
[AGENT][NEUTRAL] And this will cover uh physicians um treatment and procedures and um but it won't cover the actual office visit.
[CUSTOMER][NEUTRAL] and you
[CUSTOMER][NEUTRAL] OK, so she would still be responsible for the office visit.
[AGENT][NEUTRAL] Um, I, I can't tell you patient responsibility, but that's what the policy, that's how it processes.
[CUSTOMER][NEUTRAL] I can't tell you.
[CUSTOMER][NEUTRAL] Oh, OK, so no coverage.
[CUSTOMER][NEUTRAL] For office visit, OK, I get it, um, and then she would be covered for procedures. I'm sorry, what was the other information that you told me?
[AGENT][NEUTRAL] Um, treatment procedures, so $500 per calendar day, uh, per, per occurrence, I'm sorry.
[CUSTOMER][NEUTRAL] 3.
[CUSTOMER][NEUTRAL] Procedures, OK.
[CUSTOMER][NEUTRAL] OK, OK, uh, perfect may I please have, uh, I'm sorry, may I have your name again?
[AGENT][NEUTRAL] Uh, my name is [PII].
[CUSTOMER][NEUTRAL] [PII], thank you, and the initials of your last name?
[AGENT][NEUTRAL] Um, it's [PII].
[CUSTOMER][NEUTRAL] And I use today's date as a reference number correct?
[AGENT][POSITIVE] Yes, that's correct.
[CUSTOMER][POSITIVE] Thank you so much I appreciate it I hope you have a good day.
[AGENT][POSITIVE] Thank you for calling APLU as well.
[CUSTOMER][NEUTRAL] Bye bye.