AccountId: 011433970860
ContactId: bce45a78-7ccc-4cc7-b1a7-68f059b80c3a
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 383000 ms
Total Talk Time (AGENT): 140109 ms
Total Talk Time (CUSTOMER): 147631 ms
Interruptions: 0
Overall Sentiment: AGENT=0.8, CUSTOMER=0.5
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/04/16/bce45a78-7ccc-4cc7-b1a7-68f059b80c3a_20250416T16:56_UTC.wav
--------------------------------------------
[AGENT][NEUTRAL] Thank you for calling APL. This is [PII]. How may I help you?
[CUSTOMER][NEUTRAL] [PII], my name is [PII] and I'm calling today from Health Advocates, and I have a member on my backline, [PII], and he's calling about a recent surgery he had to see what his patient responsibility is.
[AGENT][NEUTRAL] OK, [PII], I can help you with the benefits for patients. Um, may I please get your callback number, ma'am, just in case the call is disconnected?
[CUSTOMER][NEUTRAL] Of course, uh, my call back here at Health Advocate is [PII].
[CUSTOMER][NEUTRAL] [PII].
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] Thank you, ma'am. And it's [PII], and what is his policy number?
[CUSTOMER][NEUTRAL] Uh, the policy number is 107289079.
[AGENT][NEUTRAL] OK, let me look that up.
[AGENT][NEUTRAL] OK, that's not one of our policy numbers. Do you see another number?
[CUSTOMER][NEUTRAL] Mm, that was the only number that he provided.
[AGENT][NEUTRAL] OK. Um,
[AGENT][NEUTRAL] Can you spell his first and last name for me?
[CUSTOMER][NEUTRAL] It is [PII]
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Last name is [PII]
[AGENT][NEUTRAL] OK, let me see if I can find him by the name.
[AGENT][NEUTRAL] OK. And what is um [PII]'s date of birth?
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] Thank you very much. OK, so he does have an active policy, and this is a supplemental insurance policy. It's billed secondary to the primary, and this is just to verify benefits. It's not a guarantee of payment.
[AGENT][NEUTRAL] Did he go inpatient or was he an outpatient surgery?
[CUSTOMER][NEUTRAL] I am not sure. Um, I'm happy to pull him in the call here so we can get that clarification from him.
[AGENT][NEUTRAL] Sure.
[CUSTOMER][NEUTRAL] Give me just a moment here.
[AGENT][POSITIVE] Yes, thank you.
[CUSTOMER][NEUTRAL] Interpreter and [PII], I do have a representative on the line. Her name is [PII], uh, taking a look here at this, um, gap insurance that [PII] was referring to. Um, I just needed to get you guys pulled on the call. Can you please verify with uh Mr. [PII], um, interpreter that, um, if this was an inpatient or outpatient surgery he had on, uh, the [PII]?
[CUSTOMER][NEUTRAL] Yes el seguro esta repasandolo de el seguro gap or the brea senor el dia deinve [PII] internarron of operacion and trada porsalidabulaia.
[CUSTOMER][POSITIVE] It was an outpatient I'm sorry.
[AGENT][NEUTRAL] OK, and the date of service was [PII]?
[CUSTOMER][NEUTRAL] The service your fold this in the marsal movement is sinco.
[CUSTOMER][NEUTRAL] Yes.
[AGENT][NEUTRAL] OK. And what is the name of the facility that he went to or the hospital that he went to for the surgery?
[CUSTOMER][NEUTRAL] Lombre de los pitalo de les installacionesadon deio.
[CUSTOMER][NEUTRAL] The Ambulatory Center.
[CUSTOMER][NEUTRAL] Va ambulatory Center.
[AGENT][NEUTRAL] Ambulatory Center.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] Alright, and this, like I said, it's just to verify benefits, it's not a guarantee of payment. So for outpatient, he has a per calendar day benefit of $500 that goes towards deductible, co-pay, or co-insurance.
[AGENT][NEUTRAL] Has the claim been sent in from the facility that he went to? Did they, uh, I don't see a claim, no, they haven't sent anything in.
[AGENT][NEUTRAL] So, what happens with this policy is we need to have the explanation of benefits from the primary insurance carrier first.
[AGENT][NEUTRAL] Based on what the primary pays is how we determine how we pay, but for outpatient procedures per calendar day you have a $500 benefit that goes towards deductible, co-pay or co-insurance only.
[CUSTOMER][NEUTRAL] 7 Gita.
[CUSTOMER][NEUTRAL] Elseguro primario unos and bio sotros laplicacion the beneficios.
[CUSTOMER][NEUTRAL] Primero mosqueloqueo paoloqueosest seguro DNA um beneficio de quientosqueordi on the calendario que seva asia el the copagoose.
[CUSTOMER][NEUTRAL] Yes.
[AGENT][NEUTRAL] OK. Is there anything else I can help you with before we go?
[CUSTOMER][NEUTRAL] And what is the ulna.
[CUSTOMER][NEGATIVE] No, no, no, no.
[CUSTOMER][NEUTRAL] No, nothing else.
[AGENT][POSITIVE] OK, well, you guys have a wonderful [PII] weekend and we thank you for calling APL.
[CUSTOMER][NEUTRAL] 5 gracias [PII].
[CUSTOMER][POSITIVE] Uh and I Monday. Thank you. Have a good day.
[AGENT][POSITIVE] You're very welcome. Thank you. Bye-bye.
[CUSTOMER][POSITIVE] Gracias thank you for using our service.