AccountId: 011433970860
ContactId: d408d1ab-67e6-4354-8bcd-ba776d63bcb7
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 283130 ms
Total Talk Time (AGENT): 134462 ms
Total Talk Time (CUSTOMER): 123713 ms
Interruptions: 1
Overall Sentiment: AGENT=2.1, CUSTOMER=1.3
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/05/05/d408d1ab-67e6-4354-8bcd-ba776d63bcb7_20250505T14:18_UTC.wav
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[AGENT][POSITIVE] Well thanks for calling ATL. This is.
[CUSTOMER][NEUTRAL] Um, I'm sorry, what's your name?
[AGENT][NEUTRAL] [PII].
[CUSTOMER][NEUTRAL] Hi [PII], my name is [PII] and I'm calling from Lower Keys Medical Center in [PII].
[CUSTOMER][NEUTRAL] I'm calling on a mutual member to verify benefits please.
[AGENT][NEUTRAL] Sure, [PII], I can assist you with that. Can I have this, could you provide me with the spelling of your name and a good call back number just in case the call is disconnected?
[CUSTOMER][NEUTRAL] It's [PII]
[CUSTOMER][NEUTRAL] [PII], my phone number is [PII].
[AGENT][POSITIVE] Thank you.
[AGENT][NEUTRAL] And what is that policy number that you're calling to verify benefits eligibility for?
[CUSTOMER][NEUTRAL] 02404355 M as in Mary, L as in Lima 8.
[AGENT][NEUTRAL] Thank you, [PII]. Can you verify the patient's name and date of birth?
[CUSTOMER][NEUTRAL] Patient's name is [PII] [PII].
[AGENT][NEUTRAL] Thanks, you're calling to verify benefits eligibility. This policy has been active since [PII] and it's currently active, and you're calling in regards to outpatient benefits?
[CUSTOMER][NEUTRAL] Yes.
[AGENT][NEUTRAL] This member's policy has $250 per calendar day for outpatient services and this is not a guaranteed benefits, just a disclaimer of the policy's coverage.
[CUSTOMER][NEUTRAL] OK, so let me question.
[CUSTOMER][NEUTRAL] He, he has, he's gonna do an MRI at the facility. Now he has the insurance, the Blue Cross insurance, which has a $1000 deductible for the year so far.
[CUSTOMER][NEUTRAL] And plus um
[CUSTOMER][NEUTRAL] Let me see what is his, he has a co-pay of 150. So, my question to you is, does, does this insurance cover his deductible and his co-pay for the pre um the, the.
[AGENT][NEUTRAL] Yes, this is the gap insurance. The gap insurance assists with deductible copay and co-insurance for services that went towards the primary deductible copay and co-insurance.
[CUSTOMER][NEUTRAL] Blue Cross
[CUSTOMER][NEUTRAL] OK, so with his deductible, I'm just asking about $1000 do you cover the full $1000?
[AGENT][NEUTRAL] He has $250 per calendar day, so I'm not sure how much you guys are gonna bill him for the services, however, I do know that when dealing with insurance.
[AGENT][NEUTRAL] The primary may be in network with that provider and if they're in network there's gonna be a discounted amount. So say if you charge him $800 but there's gonna be a discounted rate. So whatever the allowed amount is that went towards deductible copay and co-insurance, you need to send that ELB along with the claim here to American Public Life.
[AGENT][NEUTRAL] To verify what we will pay on it, the member has $250 per calendar day for outpatient benefits, and this is not a guarantee of benefits, just a disclaimer of the policy's coverage.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] So most likely you would just pay because that's a one time test he's coming in for so you probably will be 250 just to what his whatever his deductible is or whatever we charge.
[AGENT][NEUTRAL] Mhm.
[AGENT][NEUTRAL] Yes ma'am, whatever went to it once you submit the claim.
[CUSTOMER][NEUTRAL] The most that you're gonna pay.
[AGENT][NEUTRAL] To the primary and you receive it back, you send it here along with the primary ELB showing what went towards the deductible amount, co-pay and the or the co-insurance amount.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Yeah, but what I'm trying to verify, the most that you always pay for that one time test is $250.
[AGENT][NEUTRAL] That is correct because his benefits is only $250 per calendar day. You're saying that right.
[CUSTOMER][NEUTRAL] Is that what I'm getting? All right.
[CUSTOMER][NEUTRAL] The 50 it's uh for the, yes, right.
[CUSTOMER][NEUTRAL] OK, so I just wanted to make sure. [PII], what's the first initial of your last name?
[AGENT][NEUTRAL] [PII].
[CUSTOMER][NEUTRAL] Can I have a reference number for this call, please?
[AGENT][NEUTRAL] We don't provide those unfortunately you can use my name in today's date as a reference, [PII].
[AGENT][NEUTRAL] All that I gave you a whole another name.
[CUSTOMER][POSITIVE] Alright, I appreciate it.
[AGENT][POSITIVE] You're welcome. Is there anything else that I can assist you with today?
[CUSTOMER][POSITIVE] That's all right
[CUSTOMER][NEUTRAL] Oh, that's fine.
[CUSTOMER][POSITIVE] Listen, I've been called everything else, you know what, that, that's all right. You're very close, so that's all right.
[AGENT][POSITIVE] So thanks for calling APL and have a great day.
[CUSTOMER][POSITIVE] And you have a wonderful day.
[AGENT][POSITIVE] Thank you, you do the same. Goodbye.
[CUSTOMER][POSITIVE] Yes, you do the same. I appreciate it thank you.
[AGENT][POSITIVE] You're welcome bye.