AccountId: 011433970860
ContactId: c9626652-59c4-4241-8cd4-8a6165f3babb
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 255559 ms
Total Talk Time (AGENT): 127034 ms
Total Talk Time (CUSTOMER): 86201 ms
Interruptions: 0
Overall Sentiment: AGENT=1.8, CUSTOMER=1.4
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/01/10/c9626652-59c4-4241-8cd4-8a6165f3babb_20250110T17:21_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, my name is [PII] calling from provider office to check on the eligibility and the benefits.
[AGENT][POSITIVE] [PII], it would be a pleasure to assist you with eligibility and benefits. What is a good call back number?
[CUSTOMER][NEUTRAL] [PII]. This is a direct line.
[AGENT][NEUTRAL] Thank you, [PII], and what is the policy number for the patient?
[CUSTOMER][NEUTRAL] The policy number starts with 1456796.
[AGENT][NEUTRAL] And the patient's name and date of birth, please?
[CUSTOMER][NEUTRAL] [PII], and the date of birth, [PII].
[AGENT][NEUTRAL] Alright thank you and I understand did you say you're needing eligibility or claim status? I apologize.
[CUSTOMER][NEUTRAL] Eligibility and the benefits.
[AGENT][POSITIVE] Alright, well, I can help you with the eligibility and benefits for Ms. [PII]. I am showing that her policy is active.
[AGENT][NEUTRAL] Effective date is [PII].
[AGENT][NEUTRAL] And this is her secondary policy to her primary coverage.
[AGENT][NEUTRAL] And what type of benefits were you needing, [PII]?
[CUSTOMER][NEUTRAL] Um, before that, for the clarification, the effective date is [PII], I'm right?
[AGENT][POSITIVE] That is correct.
[CUSTOMER][POSITIVE] OK. Thank you so much. And may I know the benefits for the MRI? And uh I have one CPP code and one diagnosis code.
[AGENT][NEUTRAL] OK. The MRI is a covered benefit under her diagnostic testing benefit, and that benefit max is $500 per calendar year.
[CUSTOMER][NEUTRAL] $500 is the deductible.
[AGENT][NEUTRAL] That is the amount that we pay toward her deductible of her major medical.
[CUSTOMER][NEUTRAL] Mm sorry, I'm not catch that. Could you please repeat that?
[AGENT][NEUTRAL] Mhm. We're secondary, so we pay up to $500 per calendar year toward an MRI that is for her diagnostic testing.
[AGENT][NEUTRAL] And that is a per calendar year, that's the maximum that we can pay to help with their deductible, co-pay or co-insurance of a major medical, and that is a verification of coverage and not a guarantee of payment.
[CUSTOMER][POSITIVE] OK. Thank you so much. For the clarification purposes, the $500 is the maximum annual amount. I'm right?
[AGENT][NEUTRAL] That is the maximum that we can pay toward her deductible co-pay or co-insurance for that MRI.
[CUSTOMER][NEUTRAL] OK. Is there any specific deductible out of pocket?
[AGENT][NEUTRAL] Not on this policy. We're secondary to her major medical.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK. Thank you so much. But uh may I know, this is the limited benefit policy?
[AGENT][POSITIVE] My pleasure.
[AGENT][NEUTRAL] It is a secondary gap policy.
[CUSTOMER][NEUTRAL] Secondary gap policy. So this is not a limited benefit.
[AGENT][NEUTRAL] No, it's just like a supplemental.
[CUSTOMER][NEUTRAL] Supplemental. OK. May I know the plan type? What is the supplemental plan type?
[AGENT][NEUTRAL] It is a meddling gap policy.
[CUSTOMER][POSITIVE] OK, thank you so much. And uh this is the supplemental, I'm right?
[AGENT][POSITIVE] That is correct.
[CUSTOMER][POSITIVE] OK, thank you so much. And um
[CUSTOMER][NEUTRAL] Could you please spell your name?
[AGENT][NEUTRAL] My name is [PII]
[AGENT][NEUTRAL] First initial and my last name is [PII].
[AGENT][POSITIVE] And it was a pleasure
[CUSTOMER][NEUTRAL] And the call reference number?
[AGENT][POSITIVE] The call reference number is my name and today's date, and it was a pleasure to assist you with those benefits, [PII]. Anything else I can help you with today?
[CUSTOMER][POSITIVE] No thank you so much for all that information. Take care bye bye happy weekend.
[AGENT][NEUTRAL] And
[AGENT][POSITIVE] Happy weekend to you as well, and thank you for calling APL. Take care, [PII].
[CUSTOMER][NEUTRAL] Bye.
[AGENT][NEUTRAL] Bye bye.