AccountId: 011433970860
ContactId: d25ccf39-071f-4e99-9f60-7e54aa04d1b8
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 227679 ms
Total Talk Time (AGENT): 87566 ms
Total Talk Time (CUSTOMER): 49260 ms
Interruptions: 0
Overall Sentiment: AGENT=1.6, CUSTOMER=0.6
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/04/15/d25ccf39-071f-4e99-9f60-7e54aa04d1b8_20250415T19:45_UTC.wav
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[AGENT][POSITIVE] Thank you for calling APR. This is [PII]. How can I help you?
[CUSTOMER][NEUTRAL] Hi I was calling to see if I could get some.
[CUSTOMER][NEUTRAL] Benefits for a patient?
[AGENT][POSITIVE] Yes, ma'am. I can assist you with benefits. Um, first, could I get your name and a good callback number?
[CUSTOMER][NEUTRAL] Yeah my name is [PII] number is [PII].
[AGENT][NEUTRAL] OK. Thank you, [PII]. Now, could I get the policy number, please?
[CUSTOMER][NEUTRAL] It is 02584155.
[AGENT][NEUTRAL] And please verify the patient's name and date of birth.
[CUSTOMER][NEUTRAL] It's [PII], it's [PII].
[AGENT][NEUTRAL] OK, and just submit advise you that verification of coverage does not guarantee payment of clients. Um, the effective date on this policy was [PII]. The policy is still active and is this for inpatient or outpatient benefits or an office visit?
[CUSTOMER][NEUTRAL] It's gonna be outpatient surgery.
[AGENT][NEUTRAL] OK. For outpatient, let's see.
[AGENT][NEUTRAL] And one moment, the benefits are coming up.
[CUSTOMER][NEUTRAL] Oh, that's fine.
[AGENT][NEUTRAL] Thank you. OK, for outpatient, we cover up to 3000 per calendar year and that's for the co-pay, the co-insurance, and the deductible after the primary insurance processes the claim.
[CUSTOMER][NEUTRAL] OK, um, how much is the deductible for this plan?
[AGENT][NEUTRAL] OK, one moment.
[CUSTOMER][NEUTRAL] Because I've got an EOB for office visits and it said everything was applied to deductible.
[AGENT][NEUTRAL] Right, let's see.
[AGENT][NEUTRAL] OK. The deductible is 3000 per calendar year.
[CUSTOMER][NEUTRAL] And can you tell me how much of that is met?
[AGENT][NEUTRAL] Yeah, one moment. Let's see.
[AGENT][NEUTRAL] OK, for [PII], so far, um, $1,019.70 has been applied to her deductible.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] And do y'all require pre-certification for anything or do y'all just cover it if the primary covers it?
[AGENT][NEUTRAL] Right, we just cover it if the primary covers it and if it's um uh if the treatment is for an illness or an injury. If it's for a screening, then it's not covered.
[CUSTOMER][NEUTRAL] OK, yeah, it's not a screening. She's having surgery to have something fixed in her foot, OK.
[AGENT][NEUTRAL] OK. Is there anything else I can assist you with?
[CUSTOMER][POSITIVE] Thank you very much.
[CUSTOMER][NEUTRAL] That was it.
[AGENT][POSITIVE] OK, thank you again, [PII] for calling APL. You have a great rest of your day. Mm bye.
[CUSTOMER][POSITIVE] Thank you you too bye bye.
[AGENT][POSITIVE] Thank you.