AccountId: 011433970860
ContactId: c848bc19-031b-4716-a68b-d566d9286ffa
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 177759 ms
Total Talk Time (AGENT): 96967 ms
Total Talk Time (CUSTOMER): 58661 ms
Interruptions: 0
Overall Sentiment: AGENT=0.9, CUSTOMER=1.1
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/02/11/c848bc19-031b-4716-a68b-d566d9286ffa_20250211T19:27_UTC.wav
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[AGENT][NEUTRAL] Thank you for calling API. This is [PII]. How can I help you?
[CUSTOMER][NEUTRAL] OK
[CUSTOMER][POSITIVE] Hi, good afternoon. I'm calling to get benefits on a patient, please.
[AGENT][POSITIVE] Yes, ma'am. I can assist you with benefits. Um, first I'll need your name and a good callback number.
[CUSTOMER][NEUTRAL] My name is [PII], and my callback number is [PII].
[AGENT][NEUTRAL] Thank you, [PII]. Now I need the policy number, please.
[CUSTOMER][NEUTRAL] 01611767 ML 8.
[AGENT][NEUTRAL] Please verify the patient's name and date of birth.
[CUSTOMER][NEUTRAL] The patient's name is [PII]. Date of birth is [PII].
[AGENT][NEUTRAL] And just let me advise you that verification of coverage does not guarantee payment of claims. Um, the effective date on this policy was [PII], and the policy is still active. Um, is this for inpatient or outpatient benefits or an office visit?
[CUSTOMER][NEUTRAL] An office visit with a specialist.
[AGENT][NEUTRAL] OK. For office visits, we cover up to 1500 per calendar year and that's for the co-insurance and the deductible after the primary insurance processes the claim, but the co-pay for the office visit is not covered.
[CUSTOMER][NEUTRAL] OK
[CUSTOMER][NEUTRAL] So, um, if they were to get like a procedure done in the office, they would have to pay their, say that they're subject to a deductible, um, with their primary insurance. They would have to pay that and then you guys would refund them or we refund them. How would that work?
[AGENT][NEUTRAL] You know, what normally happens is
[CUSTOMER][NEUTRAL] Or we just don't charge them?
[AGENT][NEUTRAL] Right. You don't charge them the um co-insurance or the deductible. She still has a co-pay. Um, we don't cover the copay, so she'll still pay that, but you'll file the claim with the primary insurance company. And once you receive the EOB from the primary insurance company, you'll file a claim with us and send the EOB so we'll know how much to pay because again, we'll cover up to $1500 per calendar year for the charges that go towards the co-insurance and the deductible.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][POSITIVE] OK, perfect.
[CUSTOMER][NEUTRAL] Could I get a reference number, please?
[AGENT][NEUTRAL] Yes, for the reference number, you can use my name and today's date. My name is [PII], um it's spelled [PII] My last initial is [PII] and today's date. Is there anything else that I can assist you with?
[CUSTOMER][POSITIVE] No, that'll be all. Thank you.
[AGENT][POSITIVE] Mhm. Thank you, [PII], for calling APL. Have a great rest of your day. Mm bye.
[CUSTOMER][NEUTRAL] You too, bye.
[AGENT][NEUTRAL] Mm