AccountId: 011433970860
ContactId: 9ccde935-9d5d-4e59-bfdb-b46a523d55fb
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 237850 ms
Total Talk Time (AGENT): 104611 ms
Total Talk Time (CUSTOMER): 96693 ms
Interruptions: 0
Overall Sentiment: AGENT=1.1, CUSTOMER=1.6
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/06/02/9ccde935-9d5d-4e59-bfdb-b46a523d55fb_20250602T15:45_UTC.wav
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[AGENT][NEUTRAL] This is [PII] with APL. How can I help you?
[CUSTOMER][NEUTRAL] Hey [PII], my name is [PII]. I'm giving you a call from AdventHealth Hospital and um I have a patient coming in for a procedure. I want to verify or see if um what cover is available through this insurance for the patient for outpatient procedure.
[AGENT][NEUTRAL] OK, I can help you with benefits. Um, [PII], can I get a good callback number in case we get disconnected?
[CUSTOMER][NEUTRAL] [PII].
[AGENT][POSITIVE] Thank you so much. And do you have the policy number?
[CUSTOMER][NEUTRAL] I do. It's going to be um 021-89208 and then I have ML and then the number 8.
[AGENT][POSITIVE] OK, thank you so much give me just a moment while I look that up.
[CUSTOMER][POSITIVE] Thank you.
[AGENT][NEUTRAL] Can I get you to verify the patient's name and date of birth?
[CUSTOMER][NEUTRAL] Mhm. [PII]. Date of birth is [PII].
[AGENT][POSITIVE] Thank you so much.
[AGENT][NEUTRAL] All right, and I am showing that this policy is active with an effective date of [PII] and you're wanting to know about um some
[AGENT][NEUTRAL] Outpatient services.
[CUSTOMER][NEUTRAL] So, yes, ma'am. She has a primary care insurance. So, and I, I believe this is a supplementary plan. So I want to see if it would still cover uh the uh outpatient surgery she's having.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] OK, let me look that up. And yes, this is secondary gap insurance. So when filing a claim through this insurance, we will need the EOB from the primary showing that something was paid or some benefits were paid.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Oh, OK.
[AGENT][NEUTRAL] Um, let me check and see. You said surgery, right?
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Yes ma'am mhm.
[AGENT][NEUTRAL] OK. And I will say that this is just a verification of benefits and not a guarantee of payment.
[AGENT][NEUTRAL] See what outpatient she's got.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] It looks like she has an outpatient benefit maximum of up to $1000 per calendar day.
[AGENT][NEUTRAL] Um, with a $0 deductible per um calendar day. Um, same with emergency room deductible, $0.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] It does look that it does allow surgery in a hospital outpatient facility or freestanding outpatient uh surgery facility.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] Um, and it's maximum of up to 30 days of treatment per calendar year.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][POSITIVE] Perfect, OK.
[CUSTOMER][NEUTRAL] Just added my little note here, OK.
[CUSTOMER][NEUTRAL] Alright, and then you do guys, I, I saw on her car you guys don't require authorization, do you?
[AGENT][NEUTRAL] We do not.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Alright, I think I have all that I need then um may I have the initial for your last name and if there is a reference number please?
[AGENT][NEUTRAL] Last initial is H as in hospital, and so for reference numbers, we don't do reference numbers, you can use my name and last initial in today's date.
[CUSTOMER][POSITIVE] OK, that's perfect. And the first name was um how do you spell your first name? I'm sorry, OK.
[AGENT][NEUTRAL] [PII].
[AGENT][NEUTRAL] [PII]
[CUSTOMER][POSITIVE] OK, perfect. All right, thank you so much for your time you have a wonderful day.
[AGENT][POSITIVE] Thank you for calling APL. Have a great day.
[CUSTOMER][POSITIVE] Thank you bye bye.