AccountId: 011433970860
ContactId: ba4fde5b-76da-4b9b-83fc-1b017525412e
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 271670 ms
Total Talk Time (AGENT): 119222 ms
Total Talk Time (CUSTOMER): 106836 ms
Interruptions: 0
Overall Sentiment: AGENT=0.5, CUSTOMER=0.1
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/05/21/ba4fde5b-76da-4b9b-83fc-1b017525412e_20250521T21:49_UTC.wav
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[AGENT][NEUTRAL] Thank you for calling APL. This is [PII]. How can I help you?
[CUSTOMER][NEUTRAL] Hi, this is [PII]. Initial to my last name is [PII]. I'm calling from provider's office regarding member's eligibility and benefits.
[AGENT][POSITIVE] OK, I could check eligibility and benefits for you. [PII], can I get a good call back number from you first in case we're disconnected?
[CUSTOMER][NEUTRAL] Yeah, it's [PII].
[AGENT][NEUTRAL] Thank you. And then do you have the policy number?
[CUSTOMER][NEUTRAL] Yeah, I have the policy number. It is 016734440.
[AGENT][NEUTRAL] OK and then what was the name and date of birth for the member please?
[CUSTOMER][NEUTRAL] Member's name is [PII].
[AGENT][NEUTRAL] Do you have his date of birth?
[CUSTOMER][NEUTRAL] Gre
[CUSTOMER][NEUTRAL] Yeah, date of birth is [PII].
[AGENT][NEUTRAL] OK, thank you for verifying that. 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 co-insurance after major medical pays.
[AGENT][NEUTRAL] And are we needing to look at inpatient or outpatient benefits for this number?
[CUSTOMER][NEUTRAL] Outpatient. Can I also have the type of plan that member have?
[AGENT][NEUTRAL] It is a secondary medical policy.
[AGENT][NEUTRAL] And
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] These outpatient benefits you said?
[CUSTOMER][NEUTRAL] Yeah, I need the coinsurance and deductibles.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] So that's what this policy is designed to help with after major medical pays, it is designed to help with co-pay, deductible and co-insurance. And of course I will let you know verification of coverage is not a guarantee of payment for claims. The outpatient benefit is $3000 max per calendar day.
[CUSTOMER][NEUTRAL] This is 3000 is the deductible or they are pocket expense.
[AGENT][NEUTRAL] That is the benefit amount. This policy does not have its own deductible.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] And can I know if member's plan will pick up the primary remaining deductible and coinsurance?
[AGENT][NEUTRAL] Could you repeat that? I'm sorry.
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] Can I know if the member's plan will pick up the primary remaining deductible and coinsurance?
[AGENT][NEUTRAL] This policy is designed to help with co-pay, deductible and co-insurance after major medical pays.
[CUSTOMER][NEUTRAL] After hockey.
[CUSTOMER][NEUTRAL] Can I have the claim mailing address?
[AGENT][NEUTRAL] Yes, that is [PII].
[CUSTOMER][NEUTRAL] I.
[AGENT][NEUTRAL] That is in [PII].
[CUSTOMER][NEUTRAL] I
[AGENT][NEUTRAL] Zip code is [PII].
[CUSTOMER][NEUTRAL] 9.
[CUSTOMER][NEUTRAL] I
[CUSTOMER][NEUTRAL] The starting was [PII], right?
[AGENT][POSITIVE] Correct.
[CUSTOMER][NEUTRAL] OK. OK, can I know if provider is a network with members plan?
[AGENT][NEUTRAL] This policy is not affiliated with any network. As long as major medical is willing to pay, this policy can.
[CUSTOMER][NEUTRAL] Oh, OK.
[CUSTOMER][NEUTRAL] Uh.
[CUSTOMER][NEUTRAL] Uh, what is, what is the primary insurances you would see?
[AGENT][NEUTRAL] I don't have that information. This is their secondary medical. I don't know who their primary is.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] OK. If we are in network with Medicare, then they will pay, right?
[AGENT][NEUTRAL] Whoever they have as their primary, as long as they are willing to pay, this policy can.
[CUSTOMER][NEUTRAL] Yeah
[CUSTOMER][NEUTRAL] OK. OK. Can you spell your name for me?
[AGENT][NEUTRAL] It's [PII]. Was there anything else I could help you with, guys?
[CUSTOMER][NEUTRAL] Yeah, can I have your initial, your last name?
[AGENT][NEUTRAL] It's A
[CUSTOMER][NEUTRAL] And the call reference number?
[AGENT][NEUTRAL] Reference number would just be my first name, last initial, and today's date.
[CUSTOMER][NEUTRAL] Uh
[CUSTOMER][POSITIVE] Thank you so much for assisting me today.
[AGENT][POSITIVE] Of course, thanks for calling APL have a great rest of your day.
[CUSTOMER][NEUTRAL] Bye bye.
[AGENT][NEUTRAL] Bye bye.