AccountId: 011433970860
ContactId: ba0c797c-8261-43aa-b1b7-8b443ed34c4d
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 401209 ms
Total Talk Time (AGENT): 171034 ms
Total Talk Time (CUSTOMER): 145940 ms
Interruptions: 2
Overall Sentiment: AGENT=0.7, CUSTOMER=0.4
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/03/26/ba0c797c-8261-43aa-b1b7-8b443ed34c4d_20250326T18:12_UTC.wav
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[AGENT][NEUTRAL] Thank you for calling APL. This is [PII]. How can I help you?
[CUSTOMER][POSITIVE] Hi, yes. My name is [PII] and I'm calling to get um eligibility and benefits for a patient.
[AGENT][POSITIVE] Yeah, I can check eligibility and benefits for you. Um, [PII], can I get a good call back number from you first in case we're disconnected?
[CUSTOMER][NEUTRAL] [PII]
[AGENT][NEUTRAL] Thank you. And then do you have the policy number?
[CUSTOMER][NEUTRAL] Yes, it's actually gonna be for 2 members, but um if you can please help me because I have both at the same insurance, um.
[AGENT][NEUTRAL] Sure.
[CUSTOMER][NEUTRAL] For the first one it will be 01455852.
[AGENT][NEUTRAL] OK, and uh what was the name and date of birth for this number?
[CUSTOMER][NEUTRAL] [PII] is the name, your date of birth is [PII].
[AGENT][NEUTRAL] OK, I'm sorry, what was [PII]'s last name?
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] Got it. OK, thank you for verifying that. Uh, so this policy terminated [PII]. If you'll give me one moment, I'll see if he has one that's active. It might just be a different policy number.
[CUSTOMER][NEUTRAL] So it got terminated in [PII]?
[AGENT][NEUTRAL] Yes, um, so I did check to see if he had another one that was active, uh, the last he did have another one, but that one terminated [PII], so he does not have an active policy with us.
[CUSTOMER][NEUTRAL] And then because I'm writing everything down so.
[AGENT][NEUTRAL] Sure, no, you're fine.
[CUSTOMER][POSITIVE] OK perfect.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Now for the 2nd 1.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] His last name is [PII].
[CUSTOMER][NEUTRAL] Last name and the name will be [PII] Date of birth is [PII].
[AGENT][NEUTRAL] I'm sorry, if you would first, [PII], I'm so sorry to interrupt you. Can I get that policy number first?
[CUSTOMER][NEUTRAL] 02575597
[AGENT][POSITIVE] OK thank you I appreciate it and then um the name and date of birth please.
[CUSTOMER][NEUTRAL] [PII], [PII]
[AGENT][NEUTRAL] Oh, the last name?
[CUSTOMER][NEUTRAL] Let me see.
[CUSTOMER][NEUTRAL] [PII]
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] OK, and then the date of birth please?
[CUSTOMER][NEUTRAL] Sorry?
[AGENT][NEUTRAL] Uh, did you have his date of birth, please?
[CUSTOMER][NEUTRAL] Yes, [PII].
[AGENT][NEUTRAL] OK, thank you for verifying that. uh, so this policy is currently active, um, that effective date was [PII], and this is a secondary medical policy, so it is designed to help with co-pay, deductible and co-insurance after major medical pays, and we really need to look at, uh, inpatient or outpatient benefits.
[CUSTOMER][NEUTRAL] Outpatient.
[AGENT][NEUTRAL] OK, and of course I will let you know verification of coverage is not a guarantee of payment for claims, so their outpatient benefit is on a per occurrence basis. So essentially what that means is it would be for the same ailment, um, so say he had broken his wrist, um, he has up to $500 max, uh, per treatment of that specific ailment, um, and until he has something different if does that make sense?
[CUSTOMER][NEUTRAL] So, for calendar year, he does have a $500 max.
[AGENT][NEUTRAL] There's not it's not per calendar year, it's per occurrence.
[AGENT][NEUTRAL] So for different uh any different ailments correct.
[CUSTOMER][NEUTRAL] Per current.
[CUSTOMER][NEUTRAL] So if it's for something um like an endoscopy for a sinus sinostomy.
[CUSTOMER][NEUTRAL] Or something for like ENT wise, what would that be?
[AGENT][NEUTRAL] That's one specific occur uh excuse me, occurrence, um, it's really going to be if there's something separate or if he exceeded more of that 500, um, then we wouldn't be able to pay more than that for one specific ailment, um, or one specific occurrence.
[CUSTOMER][NEUTRAL] Do, OK, hold on. Do you, are you able to check with CPT codes?
[AGENT][NEGATIVE] I am not, unfortunately.
[CUSTOMER][NEUTRAL] OK. Now, if the primary care, um, with the primary care, they have a deductible coinsurance. Will you guys, based on the occurrence, once you guys um receive claims, will you guys be able to cover 100% or just a certain percentage? Oh well all depends once claims are submitted.
[AGENT][NEUTRAL] Mhm.
[AGENT][NEUTRAL] It's not a percentage, it's up to that $500. It's up to that $500 limit, uh, that does go towards co-pay, deductible and co-insurance per occurrence.
[CUSTOMER][NEUTRAL] Percurrence. OK, there's nothing more. It's always percurrence will always be 500.
[AGENT][NEUTRAL] Yes.
[AGENT][POSITIVE] Correct, yes.
[CUSTOMER][NEUTRAL] Uh
[CUSTOMER][NEUTRAL] All right, perfect. OK um and do you guys require authorization?
[AGENT][NEUTRAL] No authorization is not required, no.
[CUSTOMER][NEUTRAL] As a secondary.
[CUSTOMER][NEUTRAL] What is your name?
[AGENT][NEUTRAL] [PII]
[CUSTOMER][NEUTRAL] Sorry, it's [PII].
[AGENT][NEUTRAL] Yeah, [PII]
[CUSTOMER][NEUTRAL] Last name [PII]? OK.
[AGENT][NEUTRAL] [PII]
[AGENT][NEUTRAL] It's [PII].
[CUSTOMER][NEUTRAL] Oh, OK. I apologize. And can I have a reference number for this call?
[AGENT][NEUTRAL] That's OK.
[AGENT][NEUTRAL] Reference number would just be my first name, last initial, and today's date. And was there anything else I could help you with, [PII]?
[CUSTOMER][POSITIVE] No, that will be all. Thank you so much.
[AGENT][POSITIVE] Of course, yeah, thanks for calling APL. I hope you have a great rest of your day.
[CUSTOMER][NEUTRAL] You as well bye bye.
[AGENT][POSITIVE] Thank you, bye bye.