AccountId: 011433970860
ContactId: a058c2e7-fa9c-4b88-8ade-9fd29bf04c56
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 387600 ms
Total Talk Time (AGENT): 126676 ms
Total Talk Time (CUSTOMER): 90508 ms
Interruptions: 0
Overall Sentiment: AGENT=0.7, CUSTOMER=0.5
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/02/04/a058c2e7-fa9c-4b88-8ade-9fd29bf04c56_20250204T16:06_UTC.wav
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[AGENT][NEUTRAL] Thank you for calling APL. This is [PII]. How may I help you?
[CUSTOMER][NEUTRAL] Good morning, [PII]. My name is [PII]. I'm calling for benefits.
[AGENT][NEUTRAL] OK, and you said your name was [PII]?
[CUSTOMER][NEUTRAL] [PII].
[AGENT][POSITIVE] [PII], OK, thank you so much. And Miss [PII], what is your callback number please just in case our call is disconnected.
[CUSTOMER][NEUTRAL] It is
[CUSTOMER][NEUTRAL] It's [PII].
[AGENT][POSITIVE] Thank you. And I'm gonna help you out with benefits. What is the patient's name?
[CUSTOMER][NEUTRAL] It's um [PII].
[AGENT][NEUTRAL] OK. And what is [PII]'s date of birth?
[CUSTOMER][NEUTRAL] It's [PII].
[AGENT][NEUTRAL] And her policy number.
[CUSTOMER][NEUTRAL] E.
[CUSTOMER][NEUTRAL] 2006254
[AGENT][NEUTRAL] OK, and what's the name of the facility you're calling from?
[CUSTOMER][NEUTRAL] Urology specialist group LLC.
[AGENT][NEUTRAL] OK, I'm gonna put you on a brief hold. I'm gonna look up this um policy for us real quick.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] OK, let's see.
[AGENT][NEUTRAL] OK, I do see that [PII] does have an active policy. The effective date is [PII].
[AGENT][NEUTRAL] And this is just to verify coverage. It's not a guarantee of payment. This is a supplemental insurance policy and it's billed secondary to the primary.
[AGENT][NEUTRAL] It's a gap plan that helps with deductible, co-pay, and coinsurance.
[AGENT][NEUTRAL] The insured has an inpatient benefit amount per calendar year of $6600 and also has an outpatient calendar year benefit of $6600.
[CUSTOMER][NEUTRAL] OK. Give me 1 2nd.
[CUSTOMER][NEUTRAL] Uh, and what, which is the affected day of the patient?
[AGENT][NEUTRAL] The effective date is [PII].
[CUSTOMER][NEUTRAL] [PII]. OK, hold on.
[CUSTOMER][NEUTRAL] Oh
[CUSTOMER][NEUTRAL] OK
[CUSTOMER][NEUTRAL] So you cover outpatient diagnostic services up to 6000?
[AGENT][NEUTRAL] $6600 for deductible, co-pay, or co-insurance.
[CUSTOMER][NEUTRAL] Uh-huh. OK. The patient has met anything so far this year?
[AGENT][NEUTRAL] Let me look.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEGATIVE] No, nothing has been used.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Give me 1 2nd.
[CUSTOMER][NEUTRAL] OK, office visit Disco?
[AGENT][NEUTRAL] Let me check on the
[CUSTOMER][NEUTRAL] First.
[AGENT][NEUTRAL] Patience, let me look real quick.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] I'm gonna pull in the patient's policy and read and see if office visits are covered so it's gonna be just a sec while the computer pulls it in for us.
[CUSTOMER][NEUTRAL] That's OK.
[CUSTOMER][POSITIVE] Yes I can.
[AGENT][NEUTRAL] Just wanna make sure because some of these policies do have it but most of them don't, but I wanna make sure.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] OK, I'm scrolling through to read now for you.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] OK, it's no physician's office is not covered.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK. Um, I would like to know copays and deductible from the primary in office are our patients responsibility.
[AGENT][NEUTRAL] Uh, we don't give patient responsibility because that's determined by the provider.
[CUSTOMER][NEUTRAL] OK, so you pick up all the deductible, the insurance, and the co-pay on the primary.
[AGENT][NEUTRAL] Right, for covered procedure.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK. So let's see, effective date of the patient is [PII]. All the patient diagnostic services are covered up up to $6600 even. So far, nothing has been met.
[CUSTOMER][NEUTRAL] Um, you pick up all the deductible coinsurance and copay from the primary and office visit is not covered by you guys.
[AGENT][POSITIVE] Correct.
[CUSTOMER][NEUTRAL] OK. Thank you. Sorry, may I have please the call reference number?
[AGENT][NEUTRAL] Yes, you can use my name, [PII], and today's date.
[CUSTOMER][POSITIVE] OK. Thank you so much.
[AGENT][POSITIVE] You're very welcome. You have a good day and thanks for calling APL.
[CUSTOMER][POSITIVE] You too. Thank you so much bye bye.
[AGENT][NEUTRAL] Bye-bye.