AccountId: 011433970860
ContactId: b8e5a331-e234-4d80-825b-a3aa3f0e6da3
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 344609 ms
Total Talk Time (AGENT): 144625 ms
Total Talk Time (CUSTOMER): 83484 ms
Interruptions: 2
Overall Sentiment: AGENT=0.5, CUSTOMER=2.1
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/05/19/b8e5a331-e234-4d80-825b-a3aa3f0e6da3_20250519T14:06_UTC.wav
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[AGENT][NEUTRAL] Thank you for calling APL. This is [PII]. How can I help you?
[CUSTOMER][NEUTRAL] Hi [PII], good morning. This is [PII]. I'm calling from Valley Baptist here in [PII]. I was calling to see um benefits for a patient for a surgery.
[AGENT][NEUTRAL] Sure, I can help you with benefits. You said you're with Valley Hospital?
[CUSTOMER][NEUTRAL] Valley Baptist Medical Center Brownsville.
[AGENT][NEUTRAL] And what's a good callback number in case we get disconnected?
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] OK, one moment.
[CUSTOMER][POSITIVE] OK, thank you.
[AGENT][NEUTRAL] And what's the policy number?
[CUSTOMER][NEUTRAL] Policy is 01868845.
[AGENT][NEUTRAL] Give me one moment to look it up.
[CUSTOMER][POSITIVE] Thank you.
[AGENT][NEUTRAL] Can I get you to verify the patient's name and date of birth?
[CUSTOMER][NEUTRAL] Yes ma'am, I have uh [PII].
[CUSTOMER][NEUTRAL] I sit by that I have [PII].
[AGENT][POSITIVE] OK, thank you so much.
[AGENT][NEUTRAL] Alright, I'm showing this policy is active with an effective date of [PII].
[AGENT][NEUTRAL] And you are wanting
[AGENT][NEUTRAL] Uh, to see if she has surgery benefits.
[CUSTOMER][POSITIVE] Yes, for benefits.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] And I will say this is a secondary gap policy. So before uh filing a claim through this policy, you'll want to file through their major medical first, because if, major medical denies it, then this policy will also deny it.
[CUSTOMER][POSITIVE] Correct.
[CUSTOMER][NEUTRAL] So if her primary uh denies then, um, this insurance will deny.
[AGENT][NEUTRAL] Right, because this is secondary gap.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] OK, give me one moment.
[CUSTOMER][NEUTRAL] And
[AGENT][NEUTRAL] Oh, go ahead.
[CUSTOMER][NEUTRAL] Uh.
[CUSTOMER][NEUTRAL] Yeah, because she has her primary it's Blue Cross Blue Shield.
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] And then she has secondary um the APL.
[AGENT][NEUTRAL] OK, yeah, this would be secondary.
[AGENT][NEUTRAL] Let me see.
[AGENT][NEUTRAL] Give me one moment while I pull up her policy.
[CUSTOMER][POSITIVE] OK, thank you so much I appreciate it.
[AGENT][POSITIVE] You're welcome.
[AGENT][NEUTRAL] Now I do want to state that this is just a verification of benefits and not necessarily a guarantee of payment.
[CUSTOMER][NEUTRAL] OK
[AGENT][NEUTRAL] Computer's taking a little bit of time, so give me just a second.
[CUSTOMER][POSITIVE] That's OK, no worries, it's Monday, yeah.
[AGENT][NEUTRAL] It's Monday morning for my computer.
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][POSITIVE] No worries.
[AGENT][NEUTRAL] Right, so she does have an outpatient benefit maximum of up to $2550 per covered person per calendar year.
[AGENT][NEUTRAL] With an outpatient de she does not have an outpatient deductible through this policy.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] Let me see.
[AGENT][NEUTRAL] It looks like she does have an outpatient writer of surgery in a hospital outpatient facility or freestanding outpatient surgery center.
[AGENT][NEUTRAL] Um, it looks like it's subject to a maximum of 30 days per treatment.
[AGENT][NEUTRAL] Per covered person per calendar year. Is there anything else specifically that you'd like me to look up?
[CUSTOMER][NEUTRAL] The outpatient rider that's just letting you know that 30 days um.
[AGENT][NEUTRAL] She has a maximum of 30 days.
[CUSTOMER][NEUTRAL] How, how does that work, the 3 day because she's coming in for, OK, so to be in the hospital.
[AGENT][POSITIVE] Correct.
[CUSTOMER][POSITIVE] Like an impatient kind of? OK, perfect, OK.
[AGENT][NEUTRAL] Yeah, and that's outpatient. It looks like for in hospitals, outpatient and emergency room, she doesn't have a deductible. It's a $0 deductible.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Zero deductible. OK, perfect. So it's just the out of pocket, well, it's not the out of pocket, it's just, uh, you guys pay up to $2550.
[AGENT][NEUTRAL] Right, and that's after uh major medical. So whenever you file the claim, we'll need the explanation of benefits from major medical um to see what we can pick up afterwards to make sure that it was paid.
[CUSTOMER][NEUTRAL] OK, and then can I have a reference number for this call, [PII]?
[AGENT][NEUTRAL] We don't use reference numbers, but you can use my name in today's date, or I'm sorry, my name and my last initial which is [PII] and today's date. So [PII] and then today's date.
[CUSTOMER][POSITIVE] OK, thank you so much I appreciate it you have a wonderful day [PII].
[AGENT][NEUTRAL] Is there anything else? All right.
[AGENT][POSITIVE] You have a great day and thank you for calling APL. All right, bye.
[CUSTOMER][POSITIVE] No, that's it thank you you too.
[CUSTOMER][POSITIVE] Thank you bye bye.