AccountId: 011433970860
ContactId: c041f869-5a69-4926-ae68-7e92d607ca58
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 197309 ms
Total Talk Time (AGENT): 92554 ms
Total Talk Time (CUSTOMER): 77382 ms
Interruptions: 0
Overall Sentiment: AGENT=0.8, CUSTOMER=1
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/02/18/c041f869-5a69-4926-ae68-7e92d607ca58_20250218T15:42_UTC.wav
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[AGENT][NEUTRAL] Thank you for calling APL. This is [PII]. How can I help you?
[CUSTOMER][NEUTRAL] Hi, hi, sir, my name is [PII] I'm calling, um, just to uh verify benefits for a patient from an ambulatory service center facility.
[AGENT][NEUTRAL] OK, I could check those benefits for you. uh, [PII], can I get a good call back number from you first in case we're disconnected?
[CUSTOMER][NEUTRAL] Of course, [PII].
[AGENT][NEUTRAL] OK, thank you. And then do you have the policy number?
[CUSTOMER][NEUTRAL] Uh, policy number for the patient, yes.
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] It is 01812665.
[CUSTOMER][NEUTRAL] ML 8.
[AGENT][NEUTRAL] OK, thank you and what was the name and date of birth for the insured?
[CUSTOMER][NEUTRAL] I
[CUSTOMER][NEUTRAL] So the name is [PII] or [PII].
[AGENT][NEUTRAL] OK. Do you have the date of birth?
[CUSTOMER][NEUTRAL] And
[CUSTOMER][NEUTRAL] Yes, it is uh [PII].
[AGENT][NEUTRAL] OK, thank you for verifying that [PII]. Uh, so this policy is active. 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 this was outpatient, correct?
[CUSTOMER][NEUTRAL] Yes, outpatient.
[AGENT][NEUTRAL] OK, and of course I will let you know verification of coverage is not a guarantee of payment for claims. The outpatient benefit is $1000 max per calendar year. If you'll give me one moment, I'll see if any of that has been used.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] OK, none has been used so far this year.
[CUSTOMER][NEUTRAL] OK, so, um, she does have, um, a $750 financial responsibility. Can I apply that to this financial responsibility?
[AGENT][NEUTRAL] Mhm.
[AGENT][NEUTRAL] Yes, her major medical did pay um or contribute correct?
[CUSTOMER][POSITIVE] I believe so, yes.
[AGENT][NEUTRAL] OK, so this policy is very dependent on major medical, uh, contributing. If they do not, this policy can't pay anything. So as long as they did, uh, then this policy can help.
[CUSTOMER][NEUTRAL] OK
[CUSTOMER][NEUTRAL] Alright, let me just make sure that it did.
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] I'm looking at the primary one, OK, so yeah.
[CUSTOMER][NEUTRAL] It says
[CUSTOMER][NEUTRAL] That like for her co-insurance and all that that she didn't have to pay anything?
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] So
[CUSTOMER][POSITIVE] Yeah, uh, I guess it did help out.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] OK, yeah, so if there's any um left over from copay or deductible, then yes you can absolutely file that claim.
[CUSTOMER][NEUTRAL] OK, um, and then do I need like uh a reference number for this call?
[AGENT][NEUTRAL] Um, that's up to you. I do have one. it would just be my first name, last initial, and today's date. Uh, so my name is spelled [PII] Last initial is [PII] Was there anything else I could help you with, [PII]?
[CUSTOMER][POSITIVE] No, no, that's all thank you very much [PII].
[AGENT][POSITIVE] OK, of course, thanks for calling APL. I hope you have a great rest of your day.
[CUSTOMER][POSITIVE] You too thank you bye bye.
[AGENT][POSITIVE] Thank you. Bye-bye.