AccountId: 011433970860
ContactId: ba2e0581-819c-4d8a-8025-def8961f177e
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 444519 ms
Total Talk Time (AGENT): 135524 ms
Total Talk Time (CUSTOMER): 161278 ms
Interruptions: 1
Overall Sentiment: AGENT=0.8, CUSTOMER=0.6
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/04/07/ba2e0581-819c-4d8a-8025-def8961f177e_20250407T18:42_UTC.wav
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[AGENT][POSITIVE] Thanks for calling APL. This is [PII]. How can I help you?
[CUSTOMER][NEUTRAL] Hi [PII], you're speaking to [PII]. How are you doing?
[AGENT][POSITIVE] Good, how are you?
[CUSTOMER][NEUTRAL] I'm good. I'm calling from Premier Preex and like assistance verification form of patient at the office. I was wondering if you could assist.
[AGENT][NEUTRAL] Yes, I can for benefits. Is that correct?
[CUSTOMER][POSITIVE] Yes, benefits.
[AGENT][NEUTRAL] OK. And what was your name again?
[CUSTOMER][NEUTRAL] [PII]
[AGENT][NEUTRAL] [PII], OK, do you have a good callback number, [PII]?
[CUSTOMER][NEUTRAL] Yes, that will be [PII].
[AGENT][POSITIVE] OK, thank you.
[AGENT][NEUTRAL] Do you have the policy number of the patient?
[CUSTOMER][NEUTRAL] Yes, uh, that's 60801.
[AGENT][NEUTRAL] Um, that's our payer ID.
[AGENT][NEUTRAL] And the policy number?
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Mm
[CUSTOMER][NEUTRAL] You said payer ID tax ID.
[AGENT][NEUTRAL] The number, yeah, the number you just gave me is our payer ID. I need the policy number of the patient.
[CUSTOMER][NEUTRAL] OK, um,
[AGENT][NEUTRAL] Or the last name or social.
[CUSTOMER][NEUTRAL] Let me try to open the eye.
[CUSTOMER][NEUTRAL] OK. Um, OK, on your card, where is it written exactly?
[AGENT][NEUTRAL] Uh, there should be a policy certificate in the bottom, maybe right or left-hand corner.
[CUSTOMER][NEUTRAL] OK, because there's a pay ID on the on the ID that the patient brought in and then certain individual, there's a group number, effective date and inpatient certificate number in hospital benefit and out benefit certificate number.
[AGENT][NEUTRAL] Yeah, the certificate number, either certificate number will work.
[CUSTOMER][NEUTRAL] Which one do you want?
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK, that's 02605420 ML 7.
[AGENT][NEUTRAL] OK. Patient name and date of birth.
[CUSTOMER][NEUTRAL] It's [PII].
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] 6054.
[CUSTOMER][NEUTRAL] 20.
[AGENT][NEUTRAL] And the date of birth?
[CUSTOMER][NEUTRAL] And uh
[AGENT][NEUTRAL] And
[CUSTOMER][NEUTRAL] Um, date of birth, that's.
[AGENT][NEUTRAL] Um,
[CUSTOMER][NEUTRAL] [PII].
[AGENT][POSITIVE] OK, thank you.
[AGENT][NEUTRAL] OK, this is not a guarantee of payment. It's a basic outline of the policy. Policy is effective [PII] and it's currently active.
[AGENT][NEUTRAL] And then do you need outpatient benefits?
[CUSTOMER][NEUTRAL] Um,
[CUSTOMER][NEUTRAL] Don't you give both, I want the dental.
[AGENT][NEUTRAL] Um, this is
[CUSTOMER][NEUTRAL] Are they different?
[AGENT][NEUTRAL] This is a medical plan. Let me see if he has dental.
[AGENT][NEUTRAL] Yeah, this is a medical like gap secondary plan for medical insurance, so it's, it's not dental. He does, I don't have a dental policy on file for him.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] So can they not get a bit of uh dental coverage under their plan?
[AGENT][NEUTRAL] It's for medical services like inpatient and outpatient hospital services.
[CUSTOMER][NEUTRAL] Yes.
[AGENT][NEUTRAL] That's, that's the type of plan this is. It's not a dental policy.
[CUSTOMER][POSITIVE] OK, I think you can just assist me as that is. I prefer the inpatient one.
[AGENT][NEUTRAL] OK, so is he gonna be inpatient in the hospital overnight?
[CUSTOMER][NEUTRAL] Yes.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] OK, uh, not a guarantee of payment basic outline of the policy for inpatient hospital benefits.
[CUSTOMER][NEUTRAL] Oh, sorry, can I
[CUSTOMER][NEUTRAL] I think I, uh, what, is it possible for me to get both?
[AGENT][POSITIVE] Yes, I can give you both.
[CUSTOMER][POSITIVE] OK, cool. OK, cool. So let me start with the inpatient ones.
[CUSTOMER][NEUTRAL] In hospital benefits.
[AGENT][NEUTRAL] So for inpatient hospital benefits, it's $1000 per calendar year that it will pay out.
[AGENT][NEUTRAL] And this works with the primary insurance, so it will potentially pick up up to 1000 of the after the primary processes the claim.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] And then for outpatient?
[AGENT][NEUTRAL] Uh, it's also the same, $1000 per covered person per calendar year benefit.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] It's also the same, so let me just put this in brackets.
[CUSTOMER][NEUTRAL] And 11,000.
[CUSTOMER][NEUTRAL] Out of hospital.
[CUSTOMER][NEUTRAL] OK. And then are there any deductibles?
[AGENT][NEUTRAL] No, there's no deductible.
[CUSTOMER][NEUTRAL] OK. And then, um, I'm looking for history for certain dental procedures.
[AGENT][NEUTRAL] Um, we, it, it's not a dental policy, so there, there won't be any history for dental.
[AGENT][NEUTRAL] This has nothing to do with dental.
[CUSTOMER][NEUTRAL] Oh, OK.
[CUSTOMER][NEUTRAL] OK, no history because it's not a dental plan. OK.
[CUSTOMER][NEUTRAL] 8.
[CUSTOMER][NEUTRAL] A dental plan.
[CUSTOMER][POSITIVE] Cool, cool.
[CUSTOMER][NEUTRAL] OK, cool, um.
[CUSTOMER][NEUTRAL] Let me just get the reference number.
[CUSTOMER][NEUTRAL] So, of the 1000, how much have they used?
[AGENT][NEUTRAL] Um, let me see.
[AGENT][NEUTRAL] Um, nothing's been used so far this year.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Oh.
[AGENT][NEUTRAL] OK. And then is there anything else that you need?
[CUSTOMER][POSITIVE] Um, no, that would be it. Thank you so much. Can I get the reference number?
[AGENT][NEUTRAL] Reference number is just my name, [PII], first initial and my last name, D as in dog, and today's date.
[CUSTOMER][POSITIVE] OK. And then D for dog, and then today's stage. OK, thank you so much, [PII]. Have a nice day.
[AGENT][POSITIVE] OK, thanks for calling APL you as well.
[AGENT][NEUTRAL] Yeah.