AccountId: 011433970860
ContactId: a9e4deb3-19b1-49d5-b3fd-332bc5fa8bf0
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 239850 ms
Total Talk Time (AGENT): 142542 ms
Total Talk Time (CUSTOMER): 69354 ms
Interruptions: 0
Overall Sentiment: AGENT=0.5, CUSTOMER=0.6
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/03/19/a9e4deb3-19b1-49d5-b3fd-332bc5fa8bf0_20250319T19:22_UTC.wav
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[AGENT][NEUTRAL] Thank you for calling APL. This is [PII]. How may I help you today?
[CUSTOMER][NEUTRAL] Hi, my name is [PII]. Last name initial [PII]. I'm trying to verify a patients, um.
[CUSTOMER][NEUTRAL] The eligibility for a for a plan?
[AGENT][NEUTRAL] That
[AGENT][POSITIVE] OK, [PII], I'll be glad to help you. Go ahead and give me a good policy number.
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] Alright, [PII], now the patient's policy number, please, sir?
[CUSTOMER][NEUTRAL] Please. Uh, policy number is 2501816 M as in Mike L as in Lima 8.
[AGENT][NEUTRAL] All [PII]. Thank you so much, [PII], for all that information. Let me get that pulled up. Let's see. OK, what's your patient's name and date of birth today, please, sir?
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Patient's name is [PII]. Date of birth is [PII].
[AGENT][NEUTRAL] All [PII], [PII], thanks so much for all that information. Looks like she is the insured on this medical supplemental plan. Do show the original effective date. It's [PII]. She is current and active, but I must advise that verification of coverage is not a guarantee of payment on the claim, but you did say you want some type of benefit. Is that correct, [PII]?
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Um,
[CUSTOMER][NEUTRAL] No, actually I just wanted to know if the plan was active, by any chance, do you know? Mhm. Do you know by any chance how much funds does the patient have?
[AGENT][NEUTRAL] Is that, OK.
[AGENT][NEUTRAL] How much what?
[CUSTOMER][NEUTRAL] The fonts, like um.
[AGENT][NEUTRAL] How much, how much, um, what are the benefits, basically?
[CUSTOMER][NEUTRAL] Yeah.
[AGENT][NEUTRAL] Oh, let me get over to that screen. Now, what exact benefit are you calling on? Like office visit, hospital, what?
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] This
[CUSTOMER][NEUTRAL] OK, let me see. It's for an outpatient, this patient is getting an ultrasound?
[AGENT][NEUTRAL] OK, so basically outpatient. OK, let me get over to that screen. [PII], thank you for that. All right, let's see. Now what we are, of course, is her medical supplemental plan. So the only thing that we would pick up and pay on is for sickness or injury that is applied towards patients deductible, co-pay, or co-insurance at their primary insurance company.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] Now what we do is coordinate benefits with the primary for outpatient benefit here it's a zero deductible, no pre-cert, and patient has $2500 per calendar year benefit here.
[CUSTOMER][POSITIVE] OK perfect.
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Has the patient mean anything or no?
[AGENT][NEUTRAL] Let's see, she's met anything.
[AGENT][NEUTRAL] Yeah, looks like she has. Let's see how much.
[AGENT][NEUTRAL] Hm.
[AGENT][NEUTRAL] Well, it looks like as of today for [PII], she's used $1,139.20 of her outpatient benefit for 2025.
[CUSTOMER][POSITIVE] OK perfect thank you so much. Can I get your name and last name initial?
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] My name is [PII]. That is spelled [PII], we don't give um reference numbers, but you can use my name in today's date, and is that all I can help you with?
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][POSITIVE] Perfect, thank you so much [PII]. Have a great day, OK?
[AGENT][POSITIVE] You as well, [PII], and thanks for calling APL. Have a good one. Bye-bye.
[CUSTOMER][NEUTRAL] Mhm you too bye bye.