AccountId: 011433970860
ContactId: cd7597b7-c2b0-4d56-a634-3d61f7bf3da7
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 245740 ms
Total Talk Time (AGENT): 60671 ms
Total Talk Time (CUSTOMER): 65200 ms
Interruptions: 0
Overall Sentiment: AGENT=0.5, CUSTOMER=0
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/01/30/cd7597b7-c2b0-4d56-a634-3d61f7bf3da7_20250130T19:11_UTC.wav
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[AGENT][NEUTRAL] For calling APM my name is [PII]. How may I assist you today?
[CUSTOMER][NEUTRAL] Hello, [PII]. I'm trying to get um
[CUSTOMER][NEUTRAL] Eligibility and benefits on a patient.
[AGENT][POSITIVE] I'll be happy to assist with benefits and eligibility. May I have your first name, please?
[CUSTOMER][NEUTRAL] My first name is [PII]. Last name initial is [PII].
[AGENT][NEUTRAL] And what is the policy number?
[CUSTOMER][NEUTRAL] Uh, they gave me, is it 02035308 MLSL and then 8.
[AGENT][NEUTRAL] Patient's name and date of birth.
[CUSTOMER][NEUTRAL] It's [PII].
[AGENT][NEUTRAL] Date of birth?
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] Thank you for that information. Please be advised the verification of coverage is not a guarantee of payment. I do show the policy is currently active. Effective date is [PII]. And are you calling for inpatient or outpatient benefits?
[CUSTOMER][NEUTRAL] Oh.
[AGENT][NEUTRAL] I do show the outpatient calendar year maximum is $6600. Was there anything else I can assist with today?
[CUSTOMER][NEUTRAL] Yes, so I have been speaking to the patient and um cause I'm calling them to give them the cost of what we're charging, right? And when I'm talking to the patient, I'm letting her know that her responsibility of this, what we charge is this much because she has a deductible of $6000 that she has not met with her primary. Well, she's telling me that y'all usually pick up everything from that they never charged them, that y'all pick up everything, but
[CUSTOMER][NEUTRAL] What that I know of, the secondary never picks up and this patient has met the deductible on the primary.
[AGENT][NEUTRAL] But that's our sole purpose we're her gap insurance, so she has a $6000 deductible, um, you would file with the in the um primary first and then once they process the claim and let's just say they apply $6000 to her deductible, then the claim will be sent to us and then we would process it and pay the $6000. Now if it's 7000.
[AGENT][NEUTRAL] She would owe 1000 because we're only gonna pay 6000 per year.
[AGENT][NEUTRAL] But we're her gaf insurance and that, that's how it works.
[CUSTOMER][NEUTRAL] OK, give me one second, OK?
[AGENT][NEUTRAL] Hello?