AccountId: 011433970860
ContactId: ca60185a-1eff-4950-8edb-8891b96195f7
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 168520 ms
Total Talk Time (AGENT): 93084 ms
Total Talk Time (CUSTOMER): 61714 ms
Interruptions: 0
Overall Sentiment: AGENT=0.9, CUSTOMER=1.3
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/05/14/ca60185a-1eff-4950-8edb-8891b96195f7_20250514T17:11_UTC.wav
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[AGENT][NEUTRAL] Good afternoon. Thank you for calling APL. This is speaking. May I help you?
[CUSTOMER][NEUTRAL] Hi, yes, I'm calling because I need to verify benefits for a patient, please.
[AGENT][NEUTRAL] OK, I can verify benefits for you and your name is?
[CUSTOMER][NEUTRAL] [PII] [PII].
[AGENT][NEUTRAL] OK, and Ms. [PII], what is that policy number, please?
[CUSTOMER][NEUTRAL] I have here 02255824, M as in Mary, L as in Larry, 7.
[AGENT][NEUTRAL] OK, thank you. And do you have a callback number in case the call drops?
[CUSTOMER][NEUTRAL] Yes, [PII] and that's a direct line.
[AGENT][NEUTRAL] OK. Thank you, Ms. [PII] and verify that patient's name, date of birth.
[CUSTOMER][NEUTRAL] It is [PII]. Date of birth [PII].
[AGENT][POSITIVE] OK, thank you so much. And you say you're calling to verify benefits and eligibility?
[CUSTOMER][POSITIVE] Yes please.
[AGENT][NEUTRAL] OK, um, sure, and our effective date is [PII]. She is active on the policy.
[AGENT][NEUTRAL] Excuse me, I'm sorry, and what benefits are needing for this patient?
[CUSTOMER][NEUTRAL] Um, ER benefits, uh, she was seen in our emergency room last night.
[AGENT][NEUTRAL] OK, let's see, not a guarantee of payment, just a verification of coverage. With this policy, we are secondary. We help with primary insurance deductible, co-pay, and or co-insurance, and she has an outpatient benefit max up to $1000 per calendar year.
[AGENT][NEUTRAL] And she does have a $200 deductible for ER which is per current.
[CUSTOMER][NEUTRAL] So if she has her primary insurance, she has a $100 copay, would you guys pick that up?
[AGENT][NEUTRAL] Um, that's what we pick up the secondary deductible, co-pay or co-insurance up to that $1000 benefit when she's met the deductible for that, uh, occurrence.
[CUSTOMER][NEUTRAL] Or not into
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Has she met the deductible?
[AGENT][NEUTRAL] It's a percurrence deductible for ER.
[AGENT][NEUTRAL] So, no, ma'am.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK, so just sorry because I'm a little bit confused so until she meets the deductible with you guys, you won't pick up the copay from her primary insurance.
[AGENT][NEUTRAL] Correct. Deductible has to be met with us before we pay up to that $1000 benefit.
[CUSTOMER][POSITIVE] OK perfect.
[CUSTOMER][NEUTRAL] $1000 benefit per calendar year.
[AGENT][POSITIVE] Correct.
[CUSTOMER][POSITIVE] Calendar year perfect thank you so much and can I get your name?
[AGENT][NEUTRAL] Sure, it's [PII], last initial [PII].
[CUSTOMER][POSITIVE] Thank you [PII], have a great day.
[AGENT][POSITIVE] Alright, you too, Ms. [PII]. Thanks for calling APL. Bye.
[CUSTOMER][NEUTRAL] Bye bye.