AccountId: 011433970860
ContactId: ae05a6ce-2e0b-4212-8ec7-a700117d57f9
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 214360 ms
Total Talk Time (AGENT): 132856 ms
Total Talk Time (CUSTOMER): 84091 ms
Interruptions: 0
Overall Sentiment: AGENT=1.7, CUSTOMER=0.7
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/02/28/ae05a6ce-2e0b-4212-8ec7-a700117d57f9_20250228T16:23_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] Hi, my name is [PII]. I'm calling from our provider's office. I'm trying to follow up on a patient's plan, if I may.
[AGENT][POSITIVE] Yes, ma'am, and I'm so sorry I did not catch your name.
[CUSTOMER][NEUTRAL] Yeah, my name is [PII]
[AGENT][POSITIVE] Alrighty, I see, thank you for that. Now go ahead and give me a good policy number, please.
[CUSTOMER][NEUTRAL] Um, it says it's ID number 60801.
[AGENT][NEUTRAL] That is our payer ID number. Do you see anything that says certificate number SC? It's gonna be like a seven digit number, yes.
[CUSTOMER][NEUTRAL] I
[CUSTOMER][NEUTRAL] I do, I do outpatient, yeah, it's 01381893.
[CUSTOMER][NEUTRAL] ML 8.
[AGENT][NEUTRAL] That is it, [PII], and thank you for that information. Now while I'm pulling this up, go ahead and give me a good return telephone call number, please.
[CUSTOMER][NEUTRAL] [PII].
[AGENT][POSITIVE] Alright, [PII], thank you so much for all that information. Now your patient's name and date of birth today, please, ma'am.
[CUSTOMER][NEUTRAL] [PII] [PII].
[AGENT][NEUTRAL] All right, thank you for that information. Uh, it looks like [PII] is the insured on this medical supplemental plan, and you did say you want to check the status of a claim. Is that correct, [PII]?
[CUSTOMER][NEUTRAL] No, actually I just want to follow up on how it's working. Um, he's got an upcoming procedure and his primary insurance has a deductible of 1000. I didn't know if you guys take any of that or how does that work?
[AGENT][NEUTRAL] OK, alright, let me go pull the benefits up. OK, I see, what, what is that benefit is it for an office visit, in office, hospital, what type of benefit?
[CUSTOMER][NEUTRAL] hospital outpatient
[AGENT][NEUTRAL] Hospital outpatient. OK, let's see. OK, now, of course, I see, uh, you are correct. We are just a medical supplemental plan here for [PII]. Now, I do show his uh plan went into effect here [PII]. He is still current and active, but I must advise that verification of coverage is not a guarantee of payment on a claim.
[CUSTOMER][NEUTRAL] Yeah.
[AGENT][NEUTRAL] But as he is a supplemental plan carrier, what we would pick up and pay on is anything for sickness and injury that is applied towards his deductible, co-pay, or co-insurance at his primary insurance carrier. That is what we would pick up and pay on. Nothing routine here is covered no matter what. Now his outpatient benefit here is a zero deductible.
[AGENT][NEUTRAL] No pre-cert and a $1000 per calendar day benefit.
[CUSTOMER][NEUTRAL] Oh, OK, so you guys cover up to $1000.
[AGENT][NEUTRAL] Yes ma'am, per calendar day.
[CUSTOMER][NEUTRAL] For calendar day, OK, and you guys, OK, so for an out for, so it's not a routine, it's an actually outpatient surgery, so you guys would cover his deductible. OK, that's what I need to know.
[AGENT][NEUTRAL] Yes, ma'am.
[AGENT][NEUTRAL] Mhm.
[AGENT][NEUTRAL] $1000 yes, ma'am. Is that all that I can answer for you, [PII]?
[CUSTOMER][NEUTRAL] OK, uh
[CUSTOMER][NEUTRAL] Yeah, that's it. And is there a reference number for today or is it just your name and date?
[AGENT][NEUTRAL] Mhm.
[AGENT][NEUTRAL] Just my name in today's date is and. Is that all I can help you with?
[CUSTOMER][NEUTRAL] May I get your first name again please?
[AGENT][NEUTRAL] Yes, ma'am, you may. My name is [PII]. That is [PII]
[CUSTOMER][NEUTRAL] Is there an initial to that as well? May I have buffet?
[AGENT][NEUTRAL] Oh.
[CUSTOMER][POSITIVE] Thank you you have a great afternoon, OK?
[AGENT][POSITIVE] Yes, ma'am. Well, you as well, [PII], and thanks for calling APM. mhm, bye-bye.
[CUSTOMER][POSITIVE] Take care.
[CUSTOMER][NEUTRAL] OK bye.