AccountId: 011433970860
ContactId: cd1ac80e-2461-4edd-b8dc-9dd11138f480
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 165270 ms
Total Talk Time (AGENT): 66411 ms
Total Talk Time (CUSTOMER): 67645 ms
Interruptions: 0
Overall Sentiment: AGENT=0.4, CUSTOMER=1.6
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/06/09/cd1ac80e-2461-4edd-b8dc-9dd11138f480_20250609T19:12_UTC.wav
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[AGENT][POSITIVE] Good morning or good afternoon. Thank you for calling APL. This is [PII]. May I help you?
[CUSTOMER][NEUTRAL] Hello, my name is [PII].
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] And I was calling just to confirm some benefits for an outpatient procedure.
[AGENT][NEUTRAL] OK, I can verify benefits for you, Ms. [PII]. And what is that policy number, please?
[CUSTOMER][NEUTRAL] It is 022.
[CUSTOMER][NEUTRAL] 03776
[AGENT][NEUTRAL] Thank you. And do you have a callback number in case the call drops?
[CUSTOMER][NEUTRAL] Yes, it's [PII].
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] OK. Thank you. And verify the patient's name, date of birth.
[CUSTOMER][NEUTRAL] Name is [PII]. Date of birth [PII].
[AGENT][NEUTRAL] OK, I'm showing her effective date is [PII]. She is active under the policy.
[AGENT][NEUTRAL] And you say you're needing outpatient benefits, is that correct?
[CUSTOMER][NEUTRAL] Yes, please.
[AGENT][NEUTRAL] OK, um, not a guarantee of payment, just a verification coverage. With the policy as secondary, we help with primary insurance deductible, co-pay, and or co-insurance, and it shows she has a benefit max of up to $1500 per calendar year.
[CUSTOMER][NEUTRAL] OK
[CUSTOMER][NEUTRAL] Alright and then has anything been met towards that?
[AGENT][NEUTRAL] Uh, no, ma'am, she hasn't used any of her benefits for this year, so it is available.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Alright, and then once that out of pocket max is met, is there any additional responsibility?
[AGENT][NEGATIVE] We just wouldn't pay anymore since they've met them if they met their benefit max. Once that 1500 is met, then they have no more benefits for the year.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][POSITIVE] Got you OK.
[CUSTOMER][NEUTRAL] Alright and then since you guys are secondary, do you guys require any pre-authorizations or pre-certifications?
[AGENT][NEUTRAL] Uh, no, ma'am, it's not required.
[CUSTOMER][NEUTRAL] OK
[CUSTOMER][POSITIVE] All righty then, perfect. Thank you so much for your help. And if I could just get a reference number, please.
[AGENT][NEUTRAL] Uh, if you like, you may use my name at today's date.
[CUSTOMER][POSITIVE] All right perfect thank you have a great rest of your day.
[AGENT][POSITIVE] Alright you too and thanks for calling APM Miss [PII].
[CUSTOMER][POSITIVE] Thank you bye bye.
[AGENT][NEUTRAL] Bye.