AccountId: 011433970860
ContactId: b675ca6c-09cf-4d24-a3b9-a0c24d156bdb
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 479630 ms
Total Talk Time (AGENT): 171970 ms
Total Talk Time (CUSTOMER): 181501 ms
Interruptions: 2
Overall Sentiment: AGENT=0.7, CUSTOMER=0.2
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/06/10/b675ca6c-09cf-4d24-a3b9-a0c24d156bdb_20250610T15:43_UTC.wav
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[AGENT][NEUTRAL] Thank you for calling APL. This is [PII]. How can I help you?
[CUSTOMER][NEUTRAL] Good morning, [PII]. My name is [PII]. This is a recorded line. I hope you are well. I am calling because I need uh benefits for a patient for American public life.
[AGENT][NEUTRAL] OK. And can you spell your name for me, please?
[CUSTOMER][NEUTRAL] [PII]?
[AGENT][NEUTRAL] OK.
[AGENT][POSITIVE] And a good callback number in case we get disconnected?
[CUSTOMER][NEUTRAL] Yeah, uh, callback number is.
[CUSTOMER][NEUTRAL] [PII].
[CUSTOMER][NEUTRAL] [PII], no extension needed.
[AGENT][NEUTRAL] OK. And what is the policy number?
[CUSTOMER][NEUTRAL] Of course, policy number is 02114557.
[CUSTOMER][NEUTRAL] Hm
[AGENT][NEUTRAL] Alright, give me just one moment.
[AGENT][NEUTRAL] And can I get you to verify the patient's name and date of birth for me, please?
[CUSTOMER][NEUTRAL] Of course.
[CUSTOMER][NEUTRAL] Patient name is [PII].
[CUSTOMER][NEUTRAL] And date of birth is [PII].
[AGENT][NEUTRAL] OK, give me just one moment.
[AGENT][NEUTRAL] All right, and you were wanting eligibility and benefits?
[CUSTOMER][NEUTRAL] Yes, deductible out of pocket, coinsurance, and co-pay.
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Uh, you follow, uh, primary guidance, right?
[AGENT][NEUTRAL] Right, so this is secondary gap insurance?
[CUSTOMER][NEUTRAL] Yeah.
[AGENT][NEUTRAL] Um, but give me just one moment.
[AGENT][NEUTRAL] Um, the policy number you gave me has an effective date of
[AGENT][NEUTRAL] [PII], the policy lapsed [PII]. Let me see if they have any active policies.
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] Alright, it looks like they do have an active policy number with us, and when you're ready, I have that policy number.
[CUSTOMER][NEUTRAL] Uh, for the primary?
[AGENT][NEUTRAL] No, this is secondary insurance. I don't have the primary insurance.
[CUSTOMER][NEUTRAL] Oh
[CUSTOMER][NEUTRAL] Uh-huh, so can you, what, what do you want exactly?
[CUSTOMER][NEUTRAL] 9
[AGENT][NEUTRAL] So this this um APL is their secondary gap insurance policy.
[AGENT][NEUTRAL] Do you need to know who their primary is?
[CUSTOMER][NEUTRAL] Uh huh.
[CUSTOMER][NEUTRAL] No, no, no, no, no, no, no, no, no, no, no. All to know if you follow primary kindness.
[AGENT][NEUTRAL] Um, as long as it's a covered service, we should be able to pick up what's left off. This policy helps with co-pay, co-insurance, and co-deductible.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Uh-huh.
[CUSTOMER][NEUTRAL] Uh huh, deductible first please.
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] OK, give me just one moment while I pull that up.
[AGENT][NEUTRAL] And inpatient or outpatient benefits?
[CUSTOMER][NEUTRAL] Huh.
[CUSTOMER][NEUTRAL] Oh, all patient, all patient.
[AGENT][NEUTRAL] Outpatient, right?
[AGENT][NEUTRAL] This is just a verification of benefits and not a guarantee of payment. It looks like they have an outpatient benefit maximum of up to $2500 per calendar year with a $0 outpatient deductible.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Uh, 22, 2, 2000, 2000.
[AGENT][NEUTRAL] Oh.
[AGENT][NEUTRAL] 2500. Mhm.
[CUSTOMER][NEUTRAL] 2500. OK, you are the best and remaining deductible?
[AGENT][NEUTRAL] And they have a $0 deductible per calendar year.
[CUSTOMER][NEGATIVE] Oh my gosh, $0 remaining and out of pocket.
[AGENT][NEUTRAL] Oh, are you wanting to know what they've already used?
[CUSTOMER][NEUTRAL] Yeah, deductible, individual, deductible, out of pocket, co-insurance and copay.
[AGENT][NEUTRAL] OK, I was just giving you the benefits that they have on this policy. Let me look up what they've used.
[CUSTOMER][NEUTRAL] Yeah.
[AGENT][NEUTRAL] It looks like they have only used $484.69. So they have about $2100 left.
[CUSTOMER][NEUTRAL] Ah.
[CUSTOMER][NEUTRAL] 400 at [PII].
[CUSTOMER][NEUTRAL] 2100 left, right?
[AGENT][NEUTRAL] Um, about roughly, yes, because they've used 484.
[CUSTOMER][NEUTRAL] How about OK.
[CUSTOMER][NEUTRAL] Oh, OK, and out of pocket?
[AGENT][POSITIVE] We don't determine patient responsibility, so this helps pick up their out of pocket expenses.
[CUSTOMER][NEUTRAL] 00 out of pocket.
[CUSTOMER][NEUTRAL] or familiar of pocket do you have?
[AGENT][NEUTRAL] Uh, we don't determine what.
[AGENT][POSITIVE] Their responsibility is that this does help pick up their out of pocket expenses.
[CUSTOMER][NEUTRAL] Oh, so you don't have it, OK.
[AGENT][POSITIVE] Correct.
[CUSTOMER][NEUTRAL] Uh, OK, uh, coinsurance.
[AGENT][NEUTRAL] Um, what information would you like regarding their co-insurance?
[CUSTOMER][NEUTRAL] Uh, uh, outpatient hospital.
[CUSTOMER][NEUTRAL] Uh, what, what? 2030, 50, 0.
[AGENT][NEUTRAL] Um, OK, so this is gap insurance, so it helps cover all of those. Um, all of them combined would be a maximum, uh, for outpatient services. There'd be a combined maximum of $2500.
[CUSTOMER][NEUTRAL] Uh-huh, uh-huh.
[AGENT][NEUTRAL] So it's all combined.
[CUSTOMER][NEUTRAL] Oh, OK, so 00 OK.
[AGENT][NEUTRAL] Mhm, yeah, it's, it's not percentages, yeah, it's not percentages.
[CUSTOMER][NEUTRAL] OK, OK, OK, OK, OK, OK, OK, OK, um, give me a second please, let me confirm.
[CUSTOMER][NEUTRAL] OK, OK, OK.
[CUSTOMER][NEUTRAL] So, coinsurance, co-pays are included. So,
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] We are ready. Please give me a call reference number please.
[AGENT][NEUTRAL] So we don't have call reference numbers, but you can use my name and last initial in today's date, so [PII]
[CUSTOMER][NEUTRAL] Uh
[CUSTOMER][NEUTRAL] OK, uh, can you, [PII], so, uh, [PII], uh-huh, and today's day.
[AGENT][NEUTRAL] Mhm.
[AGENT][NEUTRAL] Yes, and that would be our call reference number, mhm.
[CUSTOMER][NEUTRAL] Oh
[CUSTOMER][POSITIVE] OK, you are the best. Thank you, [PII]. Have a good day.
[AGENT][POSITIVE] Thank you for calling APL. Have a great day.
[CUSTOMER][POSITIVE] Thank you.
[CUSTOMER][NEUTRAL] I like you know