AccountId: 011433970860
ContactId: aa2e4e7b-5fc5-417b-b8bc-58a8492c6d37
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 243100 ms
Total Talk Time (AGENT): 152541 ms
Total Talk Time (CUSTOMER): 68413 ms
Interruptions: 0
Overall Sentiment: AGENT=1.9, CUSTOMER=0.2
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/02/06/aa2e4e7b-5fc5-417b-b8bc-58a8492c6d37_20250206T14:13_UTC.wav
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[AGENT][POSITIVE] Good morning. Thank you for calling APL. This is [PII]. How may I help you today?
[CUSTOMER][NEUTRAL] Oh
[CUSTOMER][NEUTRAL] Hello, my name is [PII]. I'm calling from MSCB Cardiology and I'm calling to check a patient's eligibility and benefits.
[AGENT][POSITIVE] Alright, [PII], I'll be glad to help you. Go ahead and give me your policy number, please, ma'am.
[CUSTOMER][NEUTRAL] It's uh you said the phone number?
[AGENT][NEUTRAL] The uh phone number, your return telephone call number, yes, ma'am.
[CUSTOMER][NEUTRAL] OK, it's [PII].
[CUSTOMER][NEUTRAL] 5033 and my extension is [PII].
[AGENT][NEUTRAL] Alrighty, thank you for that, [PII]. Now I have the member's policy number, please?
[CUSTOMER][NEUTRAL] I have 2 02456719 ML 7.
[AGENT][POSITIVE] Alrighty, [PII], thank you so much for that information. Now what's your patient's name and date of birth today please?
[CUSTOMER][NEUTRAL] Right.
[CUSTOMER][NEUTRAL] It's [PII].
[CUSTOMER][NEUTRAL] Date of birth is [PII].
[AGENT][NEUTRAL] Alrighty, thank you for that, [PII]. It looks like Mark is the insured on this medical supplemental plan. I do show his original effective date is [PII]. Patient is active and current, but I must advise that verification of coverage is not a guarantee of payment on a claim, but she did say you want benefits. Is that correct, [PII]?
[CUSTOMER][NEUTRAL] Yes.
[AGENT][POSITIVE] Yes, ma'am. What type of benefits are you needing today?
[CUSTOMER][NEUTRAL] Um, he's coming in for an echocardiogram.
[AGENT][NEUTRAL] All righty. And where is he gonna have that done at?
[CUSTOMER][NEUTRAL] The specialist office.
[AGENT][NEUTRAL] Oh, in the office. OK, let's see.
[AGENT][NEUTRAL] All right, now what we are, [PII] is his medical supplemental plan, so the only thing that we will pick up and pay on is anything for sickness and injury that is applied towards your deductible, co-pay or co-insurance and his primary insurance carrier. Now, there's no preser here and let's see for treatment in the office, there is a
[AGENT][NEUTRAL] $500 benefit payable per calendar day with no office visit charge covered. Anything done in the office with a medical diagnosis or accident would be subject to that $500 per per calendar day benefit.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] So that's um he has a $500 deductible that he has to um pay into until you guys cover like um the Medicare deductible and co-insurance.
[AGENT][NEUTRAL] No, ma'am, no, we don't coordinate with Medicare at all. This is primary major medical coverage, but no ma'am, he don't have a deductible here at all. He has a $500 per calendar day benefit that we pay out.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] What
[CUSTOMER][NEUTRAL] Oh, OK, so that's $500 per day.
[AGENT][NEUTRAL] OK. Yes, ma'am. But we do not coordinate with Medicare at all, only a uh primary insurance carrier.
[CUSTOMER][NEUTRAL] OK, so you're not even up so because he says he has United Healthcare as primary.
[AGENT][NEUTRAL] Yes, that is who we would probably uh coordinate benefits with, as long as that's not his Medicare plan, but I think it shows he's still actively working, so he probably does have a primary, but he is, of course, over [PII], so he would, he would have Medicare as well, but we're not going to, we're not going to coordinate with Medicare, so send that primary EOB along with your claim.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] All right.
[CUSTOMER][NEUTRAL] And uh could you spell your name for me, [PII]?
[AGENT][NEUTRAL] I sure can. [PII] Is that all that I can help answer for you today, [PII]?
[CUSTOMER][NEUTRAL] Um, that is all. I just need a reference number.
[AGENT][NEUTRAL] Well, we don't give up for summers, but you can use my name in today's date if you need to do so, OK?
[CUSTOMER][POSITIVE] OK, thank you so much.
[AGENT][POSITIVE] Yes, ma'am, [PII], and thanks for calling APO. You have a great rest of your day.
[CUSTOMER][NEUTRAL] You too bye bye.
[AGENT][POSITIVE] Thank you, ma'am. Bye bye.
[CUSTOMER][NEUTRAL] Bye bye.