AccountId: 011433970860
ContactId: bf603c4a-60ea-4eba-9185-95160d843d84
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 175660 ms
Total Talk Time (AGENT): 84091 ms
Total Talk Time (CUSTOMER): 68884 ms
Interruptions: 0
Overall Sentiment: AGENT=0.8, CUSTOMER=0.8
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/01/17/bf603c4a-60ea-4eba-9185-95160d843d84_20250117T15:52_UTC.wav
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[AGENT][NEUTRAL] Good morning. Thank you for calling APL. This is [PII]. How may I assist you?
[CUSTOMER][NEUTRAL] Hey, I was calling to get benefits for a patient that's coming into my facility.
[AGENT][POSITIVE] OK, sure, I can assist you with benefits. And may I have your name?
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] And may I have a callback number just in case we get disconnected, Ms. [PII]?
[CUSTOMER][NEUTRAL] [PII]
[AGENT][NEUTRAL] Thank you and may I have the patient's policy number?
[CUSTOMER][NEUTRAL] I have 02230052 M like Mike L like Larry and then 8.
[AGENT][NEUTRAL] Thank you. And may I have the name and date of birth of the patient, Miss [PII]?
[CUSTOMER][NEUTRAL] [PII], date of birth is [PII].
[AGENT][NEUTRAL] Thank you and what type of service is being rendered for benefits?
[CUSTOMER][NEUTRAL] He's coming into a freestanding ambulatory surgical center and he's gonna be getting an upper endoscopy, an EGD.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] Right, before I give you any benefit information, I need to let you know that this is not a guarantee of payment, just a verification of coverage, and that's just a disclaimer. And this is one of our secondary supplemental plan to the major medical. We have an outpatient maximum of $750 per person per calendar day.
[CUSTOMER][NEUTRAL] Uh, sorry, 750 per person per calendar day?
[AGENT][NEUTRAL] Yes, per day, mhm.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Um, so it's not 750 for the year, it's just 750 each day.
[AGENT][POSITIVE] Correct, yes.
[CUSTOMER][NEUTRAL] OK and then is there a max limit to that or it's just as many days as they?
[AGENT][NEUTRAL] Mhm as many days as they need to use.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] And um
[CUSTOMER][NEUTRAL] So does, do you cover it directly like to the surgical center or does the patient have to bill you to be reimbursed?
[AGENT][NEUTRAL] Mhm.
[AGENT][NEUTRAL] No, we pay directly to the provider of service.
[CUSTOMER][NEUTRAL] OK, um, so 750 per person per day and then do you need like procedure codes or anything or as long as the primary is covering it, you'll pick up the remaining portion?
[AGENT][NEUTRAL] Mm
[AGENT][NEUTRAL] Correct. As long as it's approved and paid by the major medical, then we'll go ahead and consider the rest that is applied towards the deductible co-payment and co-insurance.
[CUSTOMER][NEUTRAL] OK, um, if I can just have a reference number for our call please.
[AGENT][NEUTRAL] We don't have reference numbers. You can use my name in today's date if you will. Do you need a spelling of my name or any other information, [PII]?
[CUSTOMER][NEUTRAL] Uh, yeah, if you could spell your name please.
[AGENT][NEUTRAL] Sure. That's [PII]. Last initial is [PII].
[CUSTOMER][POSITIVE] OK perfect thank you so much.
[AGENT][POSITIVE] You're welcome, Ms. [PII], and thank you for calling APL. Have a good day.
[CUSTOMER][POSITIVE] Thanks you too.