AccountId: 011433970860
ContactId: d1d17e6c-a289-4d27-9c5d-99eddac3fccc
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 183919 ms
Total Talk Time (AGENT): 100511 ms
Total Talk Time (CUSTOMER): 57388 ms
Interruptions: 0
Overall Sentiment: AGENT=0.6, CUSTOMER=0.8
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/03/17/d1d17e6c-a289-4d27-9c5d-99eddac3fccc_20250317T18:25_UTC.wav
--------------------------------------------
[AGENT][NEUTRAL] Thank you for calling APL. This is [PII]. How can I help you?
[CUSTOMER][NEUTRAL] I'm sorry, what is your name?
[AGENT][NEUTRAL] Um, it's [PII]. Um, it's spelled [PII] and my last initial is [PII].
[CUSTOMER][NEUTRAL] OK, my name is [PII] last initial [PII].
[AGENT][POSITIVE] OK, thank you, [PII] and how can I help you?
[CUSTOMER][NEUTRAL] I'm trying to find out if we're um in network and how you guys pay out to the to the patient's primary.
[AGENT][NEUTRAL] Um, yes, ma'am. I can assist you with benefits. Um, first, could I get a good callback number just in case we're disconnected?
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] Thank you. Now, I need the policy number, please.
[CUSTOMER][NEUTRAL] 025485554
[AGENT][NEUTRAL] And please verify the patient's name and date of birth.
[CUSTOMER][NEUTRAL] [PII] [PII].
[AGENT][NEUTRAL] OK. Thank you 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]. The policy is still active.
[AGENT][NEUTRAL] And yes, this is a policy for secondary gap insurance. What we do is cover the copay, the co-insurance, and the deductible. After the primary insurance processes um a claim for covered services. Um, what type of services this for? Is it for inpatient or outpatient hospital and office visit?
[CUSTOMER][NEUTRAL] It's outpatient it's outpatient ambulatory surgery center.
[AGENT][NEUTRAL] OK, for outpatient, we cover up to 1500 per calendar year. And again, that's for the co-pay, the co-insurance, and the deductible after the primary insurance processes the claim.
[CUSTOMER][NEUTRAL] You said outpatient covers up to how much?
[AGENT][NEUTRAL] 1500 per calendar year.
[CUSTOMER][NEUTRAL] Have they already exceeded that?
[AGENT][NEUTRAL] Um, no, she hasn't met anything yet this year. The full 1500 is available.
[CUSTOMER][NEUTRAL] OK, um, and then is this considered a supplemental policy?
[AGENT][NEUTRAL] Yes, it is.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK, are you able to run our tax ID to make sure that we that we're in network with us?
[AGENT][NEUTRAL] Well, there is no network. We work with our providers. Mhm.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Can I get a reference number?
[AGENT][NEUTRAL] Yes, for the reference number, you can use my name and today's date. Um my name is [PII]. It's spelled [PII] [PII] and today's date. Is there anything else that I can assist you with?
[CUSTOMER][POSITIVE] No, that's it thank you so much.
[AGENT][POSITIVE] OK. Thank you, [PII], for calling [PII]. Have a great rest of your day. Mm bye.
[CUSTOMER][POSITIVE] You too thank you bye bye.
[AGENT][NEUTRAL] Mm