AccountId: 011433970860
ContactId: b7a893c0-6970-4112-a933-99ff067e9d2b
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 268260 ms
Total Talk Time (AGENT): 131479 ms
Total Talk Time (CUSTOMER): 105678 ms
Interruptions: 0
Overall Sentiment: AGENT=1.2, CUSTOMER=0.4
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/06/04/b7a893c0-6970-4112-a933-99ff067e9d2b_20250604T17:36_UTC.wav
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[AGENT][NEUTRAL] Calling APL, this is [PII]. How may I assist you?
[CUSTOMER][NEUTRAL] Hi, I'm calling from a PCP office. I wanna know if this member is currently active.
[AGENT][POSITIVE] Sure, I can assist you with that. Can I have your name and a callback number?
[AGENT][NEUTRAL] The spelling of your name and the callback number?
[CUSTOMER][NEUTRAL] Uh, it's [PII], callback number is [PII].
[CUSTOMER][NEUTRAL] And because you said border instead of other they put over.
[AGENT][NEUTRAL] Thank you, [PII]. Can I have the policy number of the member that you're calling to verify benefits for?
[CUSTOMER][NEUTRAL] Yes, it's 02448915, M as in Mary, L as in Lucy, the number 8.
[AGENT][NEUTRAL] Can you verify the patient's name and date of birth, then I'll be able to.
[CUSTOMER][NEUTRAL] [PII]. Date of birth [PII].
[AGENT][NEUTRAL] Thank you and [PII], you're calling to verify benefits and eligibility for what place of service?
[CUSTOMER][NEUTRAL] Uh, this will be, well, the patient is actually scheduled for a PET scan, so we needed to, well, first off, I want to know if the plan is active, and second, I need to know if this requires a prior authorization.
[AGENT][NEUTRAL] This is the gap insurance, no pre-authorization is required. So the place of service will be a diagnostic testing, inpatient, outpatient service, office visit. What would the place of service be?
[CUSTOMER][NEUTRAL] The
[CUSTOMER][NEUTRAL] Outpatient.
[AGENT][NEUTRAL] So the member's policy has been active since [PII] and it's currently active. [PII] has outpatient benefits.
[CUSTOMER][NEUTRAL] Outpatient.
[AGENT][NEUTRAL] Of $500 per calendar day and this is not a guaranteed benefits just a disclaimer of the policy's coverage. However, if it's not considered as outpatient and it's considered as the treatment in the office, the treatment received in the office is covered under the outpatient benefits of the $500. However, the the the office visit itself would not be covered.
[CUSTOMER][NEUTRAL] Yeah it's gonna be outpatient on campus hospital.
[AGENT][NEUTRAL] Alright, so then our outpatient benefits is $500 per calendar per calendar day. This is not a guaranteed benefit, it's just a disclaimer of the policy's coverage. Is there anything else that I can assist you with, [PII]?
[CUSTOMER][NEUTRAL] So you said um no prior office required?
[AGENT][NEUTRAL] No, this is the gap insurance.
[CUSTOMER][NEUTRAL] OK. I will.
[CUSTOMER][NEUTRAL] Can I get a call back a call reference number?
[AGENT][NEUTRAL] We don't provide those, but you can feel free to use my name and today's date as a reference. It's [PII], and today's date.
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] Am I allowed to ask one more question?
[AGENT][NEUTRAL] You're allowed to ask a million questions. I'm not sure if I'm gonna still be here once you get almost halfway done with them, but.
[CUSTOMER][NEUTRAL] And you.
[CUSTOMER][NEUTRAL] I just have one. I, it's just one, so what is the purpose of Gap Insurance?
[AGENT][NEUTRAL] So the gap insurance assists with like the deductible, co-pay and co-insurance to her primary. Say like if her primary, I'm not sure what's her deductible or out of pocket expenses, but say if you submit the claim there and it went towards the deductible or the co-pay.
[AGENT][NEUTRAL] You will submit the claim here once you receive that EOB back from the primary insurance company because we definitely gonna need the EOB to see what went towards the deductible copay and deductible and co-insurance or out of pocket expenses we can make a payment for services that's covered under the policy.
[CUSTOMER][NEUTRAL] OK.
[AGENT][POSITIVE] Oh, gap insurance actually is good. I wish I had one.
[CUSTOMER][NEUTRAL] So you guys basically cover.
[CUSTOMER][NEUTRAL] I see,
[CUSTOMER][NEUTRAL] So you basically cover the cost of the deductible if she has one?
[AGENT][NEUTRAL] Mhm, yes.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][POSITIVE] Sounds good. OK. All right, thank you.
[AGENT][NEUTRAL] You're welcome. Do you have any other questions?
[CUSTOMER][NEUTRAL] No, that'll be no, that's it.
[AGENT][POSITIVE] So it was a pleasure speaking with you. Thanks for calling APL and have a good day.
[CUSTOMER][POSITIVE] Alright thank you.
[AGENT][POSITIVE] You're welcome. Goodbye.
[CUSTOMER][NEUTRAL] You too.