AccountId: 011433970860
ContactId: c1727668-c454-48fc-83d3-b4588dc3f10d
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 270829 ms
Total Talk Time (AGENT): 123765 ms
Total Talk Time (CUSTOMER): 105678 ms
Interruptions: 3
Overall Sentiment: AGENT=1.2, CUSTOMER=0.3
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/01/02/c1727668-c454-48fc-83d3-b4588dc3f10d_20250102T22:04_UTC.wav
--------------------------------------------
[AGENT][POSITIVE] Good afternoon thank you for calling APL my name
[AGENT][NEUTRAL] You
[CUSTOMER][NEUTRAL] Uh,
[CUSTOMER][NEUTRAL] Hi, this is [PII]. That is [PII] from Minimal Distribution Corporation checking patients' eligibility and benefits.
[AGENT][POSITIVE] Well it would be my pleasure to assist you with eligibility and benefits, [PII]. What is a good callback number?
[CUSTOMER][NEUTRAL] Uh, yeah, that is [PII].
[AGENT][NEUTRAL] Thank you, [PII]. And what is the policy number?
[CUSTOMER][NEUTRAL] You.
[CUSTOMER][NEUTRAL] Uh, that is 021-99855. Uh, Brantley, uh, [PII], and the date of birth is [PII].
[AGENT][NEUTRAL] Thank you, [PII], and the patient's name and date of birth?
[AGENT][POSITIVE] All right, thank you.
[CUSTOMER][NEGATIVE] a bad
[AGENT][POSITIVE] It would be a pleasure to assist you with that eligibility and benefits for [PII].
[CUSTOMER][NEUTRAL] I
[AGENT][NEUTRAL] I am showing at this time his policy is active.
[AGENT][NEUTRAL] Effective date is [PII].
[CUSTOMER][NEUTRAL] Yeah
[CUSTOMER][NEUTRAL] I
[AGENT][NEUTRAL] And this is a secondary gap policy to his major medical coverage.
[CUSTOMER][NEUTRAL] I am yes I am.
[AGENT][NEUTRAL] And you said you were needing benefits also?
[CUSTOMER][NEUTRAL] It
[CUSTOMER][NEUTRAL] Uh, yes, for her, and it's for diabetes supplies.
[AGENT][NEUTRAL] OK, let me check that policy and see if he has DMA coverage. Bear with me just one second.
[CUSTOMER][NEUTRAL] more.
[CUSTOMER][NEUTRAL] You didn't that like.
[CUSTOMER][NEUTRAL] Sure.
[CUSTOMER][NEUTRAL] I did 4.
[AGENT][NEUTRAL] I'm getting that pulled up Juda. Bear with me just one second.
[AGENT][NEUTRAL] He does have DMA benefits under his outpatient benefit.
[CUSTOMER][NEUTRAL] OK, sure.
[AGENT][NEUTRAL] And that benefit amount is $6600 per calendar year.
[AGENT][NEUTRAL] There is an outpatient deductible of $1000 per calendar year. Now that has not been met as of yet.
[CUSTOMER][NEUTRAL] Oh, for both, right? Uh, and, uh, out of pocket.
[AGENT][POSITIVE] That's correct.
[CUSTOMER][NEUTRAL] OK. And what about the coverage percentage that would be 100%, right? Once they met the deductible?
[AGENT][NEUTRAL] Up to that outpatient benefit of.
[CUSTOMER][NEUTRAL] OK
[AGENT][NEUTRAL] 6000.
[AGENT][NEUTRAL] $600 we can cover up to that amount.
[CUSTOMER][NEUTRAL] I'm sorry, the coverage, uh, I'm sorry, could you help me once again?
[AGENT][NEUTRAL] Sure. Once the $1000 deductible on this policy has been met, we can pay up to $6600 toward their deductible co-pay or co-insurance of the major medical.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] I'm.
[CUSTOMER][NEUTRAL] Oh, there is any percentage like that coinsurance? 80, 20 or 50%.
[AGENT][NEUTRAL] There's no
[AGENT][NEUTRAL] Yeah, so with our policy, there's only the deductible. There's no coinsurance.
[AGENT][NEUTRAL] And we paid toward the deductible co-pay or co-insurance of the major medical.
[CUSTOMER][NEUTRAL] Mhm
[CUSTOMER][NEUTRAL] OK, and this is, uh, uh, may I know the plan type?
[AGENT][NEUTRAL] It's a secondary gap policy.
[CUSTOMER][NEUTRAL] I
[CUSTOMER][NEUTRAL] Yeah, got it. Um, yeah, thank you. Can I get the reference for today's call?
[AGENT][NEUTRAL] Reference number would be my name and today's date, and I spell my name [PII], you would also please note that is a verification of coverage, not a guarantee of payment. Anything else I can help you with today?
[CUSTOMER][NEUTRAL] Yeah
[CUSTOMER][POSITIVE] Oh thank you I'm good.
[AGENT][POSITIVE] Alright, thank you for calling APL. I hope you enjoy the rest of your day and thank you for calling APL.
[CUSTOMER][POSITIVE] You too. Thank you. Bye.
[AGENT][NEUTRAL] Bye bye.
[CUSTOMER][NEUTRAL] And then