AccountId: 011433970860
ContactId: c4390c6e-b92b-4805-b8c8-e26f182fb260
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 217149 ms
Total Talk Time (AGENT): 89500 ms
Total Talk Time (CUSTOMER): 87719 ms
Interruptions: 1
Overall Sentiment: AGENT=0.9, CUSTOMER=0.5
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/04/02/c4390c6e-b92b-4805-b8c8-e26f182fb260_20250402T14:40_UTC.wav
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[AGENT][POSITIVE] Good morning. Thank you for calling APL. My name is [PII]. How may I help you?
[CUSTOMER][NEUTRAL] Hi [PII], this is [PII] from um Mount Sinai Medical Center. I'd like to verify patient benefits and eligibility.
[AGENT][NEUTRAL] OK, well, I can help you with both the eligibility and benefits. And [PII], may I have a good contact number in case we're disconnected and the policy number?
[CUSTOMER][NEUTRAL] Yeah, [PII] is a callback number and the policy number, hold on, I have it right here.
[CUSTOMER][NEUTRAL] OK, policy number 02586840.
[AGENT][NEUTRAL] Thank you, hold on one moment.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] And can you verify the member's first and last name and date of birth?
[CUSTOMER][NEUTRAL] Yeah, [PII]
[CUSTOMER][NEUTRAL] [PII] with double S. Date of birth [PII].
[AGENT][NEUTRAL] Thank you for that and all the information provided is a verification of benefits, not a guarantee of payment. And I am showing the policy is active. It's been effective since [PII].
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] And thank you. I'd like to verify that this patient has any deductible.
[AGENT][NEUTRAL] Um, let's see if there's a deductible.
[CUSTOMER][NEUTRAL] Come around please first window down, yeah.
[AGENT][NEUTRAL] Um, so, no, this is their secondary policy, so there's no deductible for this policy.
[CUSTOMER][NEUTRAL] In auto pocket, right?
[AGENT][NEUTRAL] No, not for the 2nd.
[CUSTOMER][NEUTRAL] OK, any hospitals, outpatient co-pay or coinsurance?
[AGENT][NEUTRAL] No, so as a secondary I'm sorry?
[CUSTOMER][NEUTRAL] In network please.
[CUSTOMER][NEUTRAL] I'm sorry, go ahead.
[AGENT][NEUTRAL] For the second, as the secondary insurance, we apply to the co-pay, deductible and co-insurance if primary applies it. So there's a calendar.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] year max for outpatient expenses of $4250 per person.
[CUSTOMER][NEUTRAL] OK 100.
[CUSTOMER][NEUTRAL] For 1250, right?
[AGENT][POSITIVE] Yes, that's correct.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] And uh this plan covers 20%, right?
[AGENT][NEUTRAL] No, this is their secondary insurance, so we can cover up to the 4250 per calendar year.
[CUSTOMER][NEUTRAL] OK, I get it, but you know, like sometimes the primary insurance covers 80% and the gap insurance covers 20%. Is that this case or no, just the.
[AGENT][NEUTRAL] Well, I can't guarantee the 20%. It depends on the claim. We may pay a part of it, we could pay all of it, we have to process it.
[CUSTOMER][NEUTRAL] Oh OK.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Alright, and and I can I just uh get a reference call number for this?
[AGENT][NEUTRAL] Sure, so there's no call reference number, but you can use my name in today's date. The first initial to my last name is [PII].
[CUSTOMER][NEUTRAL] Information
[CUSTOMER][POSITIVE] OK, got it, thank you and I appreciate it have a good one.
[AGENT][NEUTRAL] You're welcome, [PII]. Was there anything else I can help with?
[CUSTOMER][POSITIVE] No, that will be it thank you appreciate it.
[AGENT][POSITIVE] Alright, thanks for calling APL bye bye.
[CUSTOMER][NEUTRAL] Bye bye.