AccountId: 011433970860
ContactId: d28ea9b2-df7c-4d7f-ba94-3dfb5e0888ed
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 241979 ms
Total Talk Time (AGENT): 97236 ms
Total Talk Time (CUSTOMER): 127738 ms
Interruptions: 1
Overall Sentiment: AGENT=0.2, CUSTOMER=0
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/01/16/d28ea9b2-df7c-4d7f-ba94-3dfb5e0888ed_20250116T19:23_UTC.wav
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[AGENT][POSITIVE] Thank you for calling American Public Life. This is [PII]. How can I help you?
[CUSTOMER][NEUTRAL] Hi [PII], my name is [PII] with Merritt Health River Oaks. I have a patient that shows to have you guys as a secondary. I need to know if um that plan is still active.
[AGENT][NEUTRAL] OK, I can take a look at that for you, [PII]. Could I get a callback number?
[CUSTOMER][NEUTRAL] Yes ma'am, my direct line is [PII].
[AGENT][NEUTRAL] Thank you, the policy number you're calling on?
[CUSTOMER][NEUTRAL] They gave me 00747315.
[AGENT][NEUTRAL] And the uh the patient's name and date of birth?
[CUSTOMER][NEUTRAL] [PII] [PII].
[AGENT][NEUTRAL] OK, thank you so much for verifying the account. And you are calling to see if the policy is still active?
[CUSTOMER][NEUTRAL] He
[CUSTOMER][NEUTRAL] Yes, the original effective date for her card was [PII], so I'm just checking to see if it's still in effect.
[AGENT][NEUTRAL] Oh, OK.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] The policy is still active.
[CUSTOMER][NEUTRAL] And what
[CUSTOMER][NEUTRAL] Alright, does she have any coverage, uh, would I have to be transferred to a different number?
[AGENT][NEUTRAL] What type of, are you wanting to verify benefits?
[CUSTOMER][NEUTRAL] It said it was a very.
[CUSTOMER][NEGATIVE] If I need to, it said that it was a very limited benefits.
[AGENT][NEUTRAL] OK, I can verify the benefits for you. What type of service is she coming in for?
[CUSTOMER][NEUTRAL] Um,
[CUSTOMER][NEUTRAL] Alright.
[CUSTOMER][NEUTRAL] She's having this, as I said, it's her secondary so obviously her primary would pay first, but she's having an outpatient uh CAT scan.
[AGENT][NEUTRAL] OK, please be advised verifying benefits.
[CUSTOMER][NEUTRAL] And it would be the facility benefit.
[AGENT][NEUTRAL] Does not guarantee payment. I do show the policy does cover outpatient benefits. Uh, it looks like uh there is a $250 deductible. Once met, the policy pays up to $4000 a calendar year.
[CUSTOMER][NEUTRAL] Yes ma'am.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Has she used anything of that yet?
[AGENT][NEGATIVE] She has not used any benefits for [PII].
[CUSTOMER][NEUTRAL] OK, so I'm just gonna confirm this with you because I run into these every once in a while, but they confuse the heck out of me.
[AGENT][NEUTRAL] Mhm
[CUSTOMER][NEUTRAL] So any anything that her primary is not going to cover, you guys would pay.
[CUSTOMER][NEUTRAL] Up to at least $250 on it.
[AGENT][NEUTRAL] No. So the policy will pay towards patients responsibility after the uh primary has pay applied to deductible, co-pay or co-insurance. If it's a, if it's not covered, we do not cover it.
[CUSTOMER][NEUTRAL] Uh
[AGENT][NEUTRAL] But we, she has a $250 deductible first. Once she meets her outpatient $250 deductible, the policy pays up to $4000 a calendar year.
[CUSTOMER][NEUTRAL] Uh-huh.
[CUSTOMER][NEUTRAL] OK
[CUSTOMER][NEUTRAL] All right. That, OK.
[CUSTOMER][NEUTRAL] I'm just gonna put they'll cover it and then.
[CUSTOMER][NEUTRAL] She should know if it's gonna cover it or not.
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Cause that's, that gets confusing when I run the estimate and then it only pays partial or something cause the patient's like, I don't know, I've got a secondary and they don't, they don't understand all that, but they should know. Um.
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] But I will, I will note that for sure um so that they are aware, um, do we have a call reference number, Miss [PII]?
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] Yes, ma'am, to reference the call, you'll use my name and today's date.
[CUSTOMER][NEUTRAL] Is it [PII]?
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] Yes.
[CUSTOMER][POSITIVE] Oh, cool, got it. OK. All right, thank you very much.
[AGENT][NEUTRAL] Mhm
[AGENT][POSITIVE] You're welcome. You have a wonderful day. Thank you for calling APL. Bye-bye.
[CUSTOMER][NEUTRAL] You too.
[CUSTOMER][NEUTRAL] Yes, ma'am. Bye-bye.