AccountId: 011433970860
ContactId: abb98341-b86f-4e08-bd18-4bb980118143
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 263350 ms
Total Talk Time (AGENT): 86712 ms
Total Talk Time (CUSTOMER): 143007 ms
Interruptions: 0
Overall Sentiment: AGENT=0.2, CUSTOMER=0.3
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/01/29/abb98341-b86f-4e08-bd18-4bb980118143_20250129T14:05_UTC.wav
--------------------------------------------
[AGENT][NEUTRAL] Calling APL, this is [PII]. How may I help you?
[CUSTOMER][NEUTRAL] Yes, hello, um, I'm calling to verify benefits on a patient please.
[AGENT][NEUTRAL] OK. And your name?
[CUSTOMER][NEUTRAL] [PII] and I'm calling from Seashore Surgical.
[AGENT][NEUTRAL] And
[AGENT][NEUTRAL] Mhm. Did you say [PII] or [PII]?
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] OK. And what's the policy number?
[CUSTOMER][NEUTRAL] Just [PII] mhm.
[CUSTOMER][NEUTRAL] OK, I've got, oh wait, maybe I don't have the right person.
[CUSTOMER][NEUTRAL] Um, [PII], um, I have, sorry, let's see here, where is it, um.
[CUSTOMER][NEUTRAL] Hm
[CUSTOMER][NEUTRAL] What the group number.
[CUSTOMER][NEUTRAL] 00 no, that's payer ID.
[CUSTOMER][NEUTRAL] Oh outpatient benefit center number is that what I'm looking at?
[AGENT][NEUTRAL] Benefit er number? Uh-huh.
[CUSTOMER][NEUTRAL] Yeah, is that OK, uh 01994078 ML 8.
[AGENT][NEUTRAL] OK, and what's a good phone number in case we're disconnected, [PII]?
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] OK, and how may we help you today?
[CUSTOMER][NEUTRAL] Yes, um, this patient is gonna be seen here at our ambulatory surgery center and you need to know what benefits, um.
[CUSTOMER][NEUTRAL] Um
[CUSTOMER][NEUTRAL] This particular this is a new insurance to us so I'm just trying to establish what kind of benefits they have.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] OK. And what's the patient's um name and date of birth?
[CUSTOMER][NEUTRAL] [PII] [PII].
[AGENT][POSITIVE] OK, thank you.
[AGENT][NEUTRAL] So I'm showing a policy effective date of [PII]. Uh, this policy is active at this time, and let me pull up the benefits and I'll be able to provide that information.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] So the maximum outpatient benefit is up to $5000 and that is per calendar year.
[AGENT][NEUTRAL] And this information is verification, not a guarantee of payment?
[AGENT][NEUTRAL] Um, for [PII], I do not show any of this benefit used at this time.
[CUSTOMER][NEUTRAL] OK, alright, so, um, go ahead, sorry.
[AGENT][NEUTRAL] You know, this
[AGENT][NEUTRAL] I was gonna say this is a supplemental policy. It's secondary to the major medical plan.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Alrighty and uh da da da da.
[CUSTOMER][NEUTRAL] Do you know if let's see claims auto cross over to you or no?
[AGENT][NEGATIVE] I don't believe so.
[CUSTOMER][NEUTRAL] OK, and it says claims go to [PII], is that correct?
[AGENT][NEUTRAL] State of [PII]. Yes, that's correct.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Alright, so, um, so this will pick up um the balance after.
[CUSTOMER][NEUTRAL] After the secondary up to 50 or I'm sorry, the balance after primary up to 5000 and that's it, correct?
[AGENT][NEUTRAL] Uh, covered charges that are applied towards deductible, co-insurance, and or co-pay amounts up to 5000 per calendar year.
[CUSTOMER][NEUTRAL] OK, so, OK, does that, OK, any of those coinsurance co pick up co-pays as well, you said, right?
[AGENT][NEUTRAL] Mhm.
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] OK, go and share everything, OK, um, and I see a payer ID of 60801. Um, is this, uh, it's just a true secondary is it a PPO or HMO or?
[AGENT][NEUTRAL] To Metlink policy, just a supplement plan.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] It was just a
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][POSITIVE] Alrighty.
[CUSTOMER][NEUTRAL] So doesn't so long as it's covered by the primary you'll pick up the balance um no I believe that should be it. um, may I have your name please?
[AGENT][NEUTRAL] Any other questions?
[AGENT][NEUTRAL] Mhm.
[AGENT][NEUTRAL] Uh, you'll use my name in today's status reference, [PII] First initial last name is [PII], and this policy will only pick up deductible coinsurance and or co-pay amounts.
[CUSTOMER][POSITIVE] OK, that's just the mhm. Alright, very good. Alright, I thank you for your help and I hope you have a good rest of your day.
[AGENT][NEUTRAL] Of covered charges.
[AGENT][POSITIVE] You're welcome, [PII]. Thanks for calling APL. Have a good day.
[CUSTOMER][NEUTRAL] You as well bye bye.