AccountId: 011433970860
ContactId: ad6290fa-5ce1-4899-b568-622367508e49
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 237330 ms
Total Talk Time (AGENT): 95969 ms
Total Talk Time (CUSTOMER): 113411 ms
Interruptions: 0
Overall Sentiment: AGENT=1.1, CUSTOMER=1.1
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/06/17/ad6290fa-5ce1-4899-b568-622367508e49_20250617T14:02_UTC.wav
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[AGENT][POSITIVE] Thank you for calling APL. This is [PII]. How can I help you?
[CUSTOMER][NEUTRAL] Hi [PII], my name is [PII]. I'm calling from the surgery center because we have a patient that's coming in for surgery, um, on Thursday, and I was informed that this is his secondary insurance, and I wanted to see their benefits.
[AGENT][POSITIVE] Sure, I can take those benefits for you. uh [PII], can I get a good call back number from you first in case we're disconnected?
[CUSTOMER][NEUTRAL] Of yeah of course so our callback number would be [PII].
[AGENT][NEUTRAL] OK, thank you and then do you have that policy number?
[CUSTOMER][NEUTRAL] Um, yes, I do, uh, I have.
[CUSTOMER][NEUTRAL] Because I see they have like uh 2 certification numbers, one for in hospitals benefits and outpatient benefits.
[AGENT][NEUTRAL] Uh
[AGENT][NEUTRAL] Sure either one of those please.
[CUSTOMER][NEUTRAL] OK, I'll do the outpatient benefit one. It's gonna be 01612801 [PII].
[AGENT][NEUTRAL] OK and then uh what was the name and date of birth for the member please?
[CUSTOMER][NEUTRAL] I believe it's under his wife, uh, her name is [PII], um, but.
[CUSTOMER][NEUTRAL] Oh, I don't have her date of birth. OK, let me do, sorry, it will be [PII].
[AGENT][NEUTRAL] That's no that's OK um.
[AGENT][NEUTRAL] OK, that's fine, yes, you could just give me his information.
[CUSTOMER][NEUTRAL] Yeah, sorry about that because I didn't have her date of birth. Um, it'd be [PII] and their date of birth is [PII].
[AGENT][NEUTRAL] That's OK.
[AGENT][NEUTRAL] OK, thank you so much for verifying that. OK, so this policy is active. Effective date was [PII], and as this is a secondary medical policy, it is designed to help with co-pay, deductible and co-insurance after major medical pays, and we really need to look at the outpatient benefits, you said?
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Yes.
[AGENT][NEUTRAL] OK, and of course I will let you know verification of coverage is not a guarantee of payment for claims. The outpatient benefit is $2500 per calendar year. If you'll give me one moment, I will see if any of that has been used.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] OK, you said 2500?
[AGENT][NEGATIVE] Correct and uh none of that benefit has been used so far this year.
[CUSTOMER][NEUTRAL] OK
[CUSTOMER][POSITIVE] OK perfect um.
[CUSTOMER][NEUTRAL] OK, so, uh, more or less it would be that, um, you guys will be covering his deductible or any, uh, coinsurance, correct?
[AGENT][NEUTRAL] Right, or if there's any co-pay, um, this policy, it's very dependent on whoever they have as their primary, so as long as they're willing to pay this policy can help with those things.
[CUSTOMER][NEUTRAL] OK perfect and for submitting claims would it be electronic or paper?
[AGENT][NEUTRAL] Whatever you prefer, um, I do have a mailing address, fax number and a payer ID.
[CUSTOMER][NEUTRAL] OK, yeah, I I have the address. I just wanted to make sure because I wasn't uh.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] Sure, yeah, it's whatever you prefer.
[CUSTOMER][POSITIVE] OK perfect alrighty um.
[CUSTOMER][NEUTRAL] I think that's everything that I need for now. I just wanted to confirm if it's electronic or paper and how much they're benefits and and um.
[AGENT][NEUTRAL] Sure.
[CUSTOMER][NEUTRAL] Can I get a reference number just in case?
[AGENT][NEUTRAL] Yes, uh, reference number would just be my first name, last initial, and today's date. Uh, so my name is spelled [PII] last [PII], and there wasn't anything else I could help you with?
[CUSTOMER][POSITIVE] Um, no, that's all for now. Thank you so much for your help.
[AGENT][POSITIVE] Of course, yeah, thanks for calling APL. Have a great rest of your day.
[CUSTOMER][POSITIVE] You too have a good one.
[AGENT][POSITIVE] Thank you. Bye-bye.