AccountId: 011433970860
ContactId: d308cb73-0ab9-42aa-81c4-39f4146be2f1
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 199460 ms
Total Talk Time (AGENT): 85829 ms
Total Talk Time (CUSTOMER): 86051 ms
Interruptions: 1
Overall Sentiment: AGENT=1.3, CUSTOMER=0.9
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/04/02/d308cb73-0ab9-42aa-81c4-39f4146be2f1_20250402T18:05_UTC.wav
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[AGENT][NEUTRAL] Thank you for calling APL. This is [PII]. How can I help you?
[CUSTOMER][NEUTRAL] Hi, yes, my name is [PII] and I'm calling to get eligibility and benefits as well as authorizations for, for a patient.
[AGENT][NEUTRAL] OK, yeah, I could check eligibility benefits and see if authorization is required. Uh, [PII], can I get a good call back number from you first in case we're disconnected?
[CUSTOMER][NEUTRAL] Yes, it's gonna be [PII].
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] Thank you. And do you have that policy number?
[CUSTOMER][NEUTRAL] Yes, it's gonna be 014207.
[CUSTOMER][NEUTRAL] 51 M as in Mary, L as in Larry, number 8.
[AGENT][NEUTRAL] OK, and what was the name and date of birth for the member, please?
[CUSTOMER][NEUTRAL] Yeah
[CUSTOMER][NEUTRAL] The member's name is gonna be [PII]
[CUSTOMER][NEUTRAL] Last name is gonna be [PII]
[CUSTOMER][NEUTRAL] And date of birth will be [PII].
[AGENT][NEUTRAL] OK, thank you so much for verifying that, [PII]. So this policy is active. Effective date was [PII], and this is a secondary medical policy. So it is designed to help with co-pay, deductible and co-insurance after major medical pays. And as this policy is very dependent on major medical, no authorization is required.
[AGENT][NEUTRAL] And we really need to look at uh inpatient or outpatient benefits.
[CUSTOMER][NEUTRAL] Hold on, give me one second. So it's a secondary insurance that helps out copays co-insurance and deductibles after the primary insurance, right?
[AGENT][NEUTRAL] Oh, sure.
[AGENT][POSITIVE] Correct.
[AGENT][NEUTRAL] Yes.
[CUSTOMER][NEUTRAL] Yes, and it's gonna be for outpatient.
[AGENT][NEUTRAL] OK, and of course I will let you know verification of coverage is not a guarantee of payment for claims. So that outpatient benefit is $2500 per calendar year. If you'll give me one moment, I'll see if any, mhm.
[CUSTOMER][NEUTRAL] Oh
[CUSTOMER][NEUTRAL] Hold on, $2500 per calendar year.
[AGENT][NEUTRAL] Correct and then I can see if any of that has been used.
[AGENT][NEUTRAL] OK, uh, so yes if has not used any of this, uh, so far this year.
[CUSTOMER][NEUTRAL] So the patient has not used any of it.
[AGENT][POSITIVE] Correct.
[CUSTOMER][NEUTRAL] OK. And you said what was your name once again?
[AGENT][NEUTRAL] [PII]
[CUSTOMER][POSITIVE] Hey ladies, how are you doing again?
[CUSTOMER][NEUTRAL] [PII] last name [PII].
[AGENT][NEUTRAL] Yes, A.
[CUSTOMER][NEUTRAL] Can I have a reference number to this call?
[AGENT][NEUTRAL] Reference number would just be my first name, last initial, and today's date. Was there anything else I can help you with, [PII]?
[CUSTOMER][NEUTRAL] The
[CUSTOMER][POSITIVE] No, that will be all thank you.
[AGENT][POSITIVE] OK, yeah, thanks for calling APL. I hope you have a great rest of your day.
[CUSTOMER][POSITIVE] Thank you you as well bye bye.
[AGENT][POSITIVE] Thank you. Bye-bye.