AccountId: 011433970860
ContactId: b7a0049c-aad8-496e-b1a5-ed1923385b1a
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 267890 ms
Total Talk Time (AGENT): 163140 ms
Total Talk Time (CUSTOMER): 84678 ms
Interruptions: 0
Overall Sentiment: AGENT=0.5, CUSTOMER=1.1
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/05/29/b7a0049c-aad8-496e-b1a5-ed1923385b1a_20250529T17:23_UTC.wav
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[AGENT][NEUTRAL] Thank you for calling APL. This is [PII]. How can I help you?
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][POSITIVE] Yes, good afternoon. I would like to get some benefits for a patient please.
[AGENT][NEUTRAL] Yeah, I can check on if it's for you. uh, what was your name?
[CUSTOMER][NEUTRAL] Yes, my name is [PII].
[AGENT][NEUTRAL] OK [PII], can I get a good call back number from you in case we're disconnected?
[CUSTOMER][NEUTRAL] Sure, [PII].
[AGENT][NEUTRAL] Thank you. And then do you have that policy number?
[CUSTOMER][NEUTRAL] So
[CUSTOMER][NEUTRAL] Uh-huh, policy number is 02570559.
[AGENT][NEUTRAL] OK and then what was the name and date of birth for the member please?
[CUSTOMER][NEUTRAL] Yes, his name is [PII]. Uh, date of birth is [PII].
[AGENT][NEUTRAL] Perfect, thank you for verifying that. Uh, so this policy is active. Effective date was [PII].
[AGENT][NEUTRAL] And this is a secondary medical policy, so it is designed to help with co-pay, deductible and coinsurance after major medical pays.
[AGENT][NEUTRAL] And of course I will let you know verification of coverage is not a guarantee of payment for claims. So for this policy, the inpatient and outpatient benefits are uh combined, so that is $6000 max per calendar year and if you'll give me one moment, I will see if any of that has been used.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Let me ask you, how much is the deductible you said?
[AGENT][NEUTRAL] Sure, go ahead.
[AGENT][NEUTRAL] Oh no, not deductible, uh, that was the combined benefit amount that we would pay.
[CUSTOMER][NEUTRAL] No.
[CUSTOMER][NEUTRAL] OK, perfect. You said there is no co-payment?
[AGENT][NEUTRAL] Yes.
[AGENT][NEUTRAL] Right, give me just a moment, um.
[CUSTOMER][NEUTRAL] Um
[CUSTOMER][POSITIVE] OK perfect.
[AGENT][NEUTRAL] I'm gonna see um he has used a little bit this year so hang on just a second. OK, so he has used $1940.60 so far this year.
[CUSTOMER][POSITIVE] No worries.
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] For deductible you said or out of pocket?
[AGENT][NEUTRAL] No, so right, so this policy doesn't have any deductibles or anything like that. There's a total benefit amount that we would pay uh towards co-pay, deductible and co-insurance, so that $6000 is the maximum benefit amount that we would pay per calendar year, and of that he has used $1940.60.
[CUSTOMER][NEUTRAL] Um
[CUSTOMER][NEUTRAL] Oh,
[CUSTOMER][NEUTRAL] Oh.
[CUSTOMER][NEUTRAL] I understand. Let me see. Is there any visit limitations with this policy?
[AGENT][NEUTRAL] It is a bit
[AGENT][NEUTRAL] I'm sorry.
[AGENT][NEUTRAL] Well, it's very dependent.
[CUSTOMER][NEUTRAL] No, no worries, it's OK. Is there any basic limitation?
[AGENT][NEUTRAL] Sure, so there's, uh, this policy is very dependent on major medical, so whoever he has as his primary insurance, as long as they're willing to pay this policy can if they're not, then this policy can't.
[CUSTOMER][NEUTRAL] OK, I understand. Um, let me see, is a referral needed?
[AGENT][NEUTRAL] But no authorization or anything like that is required. No, nothing like that is required again as long as it follows major medical guidelines.
[CUSTOMER][POSITIVE] Oh, OK, perfect.
[CUSTOMER][NEUTRAL] OK, got you. What is the name of the plant? Is HMO, PPO, POS, or just a supplement, a secondary?
[AGENT][NEUTRAL] Just supplemental, yeah, secondary medical.
[CUSTOMER][NEUTRAL] OK, perfect. Give me one second. May I have your PO box or billing address please?
[AGENT][NEUTRAL] Sure, I've got a mailing address, fax number and a payer ID I can give you. Um, our mailing address is, yes, [PII].
[CUSTOMER][NEUTRAL] Please.
[AGENT][NEUTRAL] [PII].
[AGENT][NEUTRAL] And that is in [PII].
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] Zip code is [PII].
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Perfect, may I have your name and reference number please?
[AGENT][NEUTRAL] Uh yeah, reference number would just be my first name, last initial, and today's date, and so my name is spelled [PII], and did you need that fax number or payer ID [PII]?
[CUSTOMER][NEUTRAL] No, actually, no, it's not, it's, it's not necessary, no worries. So let me just to recap, you said there is no co-payment, no deductible, not out of pocket, so it's.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] Sure.
[CUSTOMER][POSITIVE] That's correct.
[AGENT][POSITIVE] Just that benefit amount that's correct.
[CUSTOMER][POSITIVE] OK perfect thank you so much for your help OK have a blessed day.
[AGENT][POSITIVE] Of course, thanks for calling APL you too bye bye.
[CUSTOMER][NEUTRAL] Bye bye.