AccountId: 011433970860
ContactId: d5c8594d-c5f1-4952-a225-e72efbc5e7d5
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 288489 ms
Total Talk Time (AGENT): 134475 ms
Total Talk Time (CUSTOMER): 72781 ms
Interruptions: 0
Overall Sentiment: AGENT=1.3, CUSTOMER=1.3
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/01/09/d5c8594d-c5f1-4952-a225-e72efbc5e7d5_20250109T13:59_UTC.wav
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[AGENT][POSITIVE] Good morning. Thank you for calling APL. This is [PII]. How can I help you?
[CUSTOMER][NEUTRAL] Hi [PII], good morning. My name is [PII]. I'm calling from Ortho now. I just wanted to verify a patient's gap insurance, please.
[AGENT][NEUTRAL] OK, EV, you said that you're needing to verify the member's gap insurance. Is that correct?
[CUSTOMER][NEUTRAL] That
[CUSTOMER][NEUTRAL] Yes, please.
[AGENT][NEUTRAL] Yes, ma'am, I can help you with that. Are you needing eligibility and benefits or just eligibility?
[CUSTOMER][NEUTRAL] Eligibility and benefits.
[AGENT][POSITIVE] Yes, ma'am, I can help you. And what is your callback number, please?
[CUSTOMER][NEUTRAL] Sure. [PII].
[AGENT][NEUTRAL] Did you say [PII]? I'm having a little trouble hearing you, [PII].
[CUSTOMER][NEUTRAL] Yes, I'm sorry, [PII].
[AGENT][NEUTRAL] Thank you. And your the member's policy number?
[CUSTOMER][NEUTRAL] Um, it is 02556081.
[AGENT][POSITIVE] Thank you one moment.
[CUSTOMER][NEUTRAL] Sure.
[AGENT][NEUTRAL] And [PII], any information that I do provide for you today will be a verification of benefits and not a guarantee of payment. So first off, what is your patient's name and date of birth?
[CUSTOMER][NEUTRAL] Um, his name is [PII] Last name [PII], uh 626-68.
[AGENT][NEUTRAL] Mhm.
[AGENT][POSITIVE] OK, thank you.
[AGENT][NEUTRAL] OK, so I do show that he is the subscriber on the supplemental policy over and it is it is active with an effective date of [PII].
[CUSTOMER][NEUTRAL] Yeah.
[AGENT][NEUTRAL] And what type of benefit information do you need inpatient, outpatient or office?
[CUSTOMER][NEUTRAL] For outpatient for urgent care visit, I just wanted to see if you guys would pick up his deductible copay or coinsurance.
[AGENT][NEUTRAL] OK, one moment for urgent care, is that correct?
[CUSTOMER][POSITIVE] Correct.
[AGENT][NEUTRAL] OK, so on this plan has outpatient benefit maximum excuse me.
[AGENT][NEUTRAL] Sorry.
[AGENT][NEUTRAL] His outpatient benefit maximum is $3000 per covered person per calendar year for covered outpatient services and there is no outpatient deductible.
[CUSTOMER][POSITIVE] Perfect and you guys will pick up the.
[CUSTOMER][NEUTRAL] The
[CUSTOMER][NEUTRAL] Co-pays and co-insurances then up to 3000.
[AGENT][NEUTRAL] Again, I cannot [PII] yes ma'am, I can't guarantee payment. I can only verify the benefit information. We'll have to receive the claim for review. Now, on this type of policy, [PII], you may already be familiar with this, but because it is a supplement to his primary insurance, we do have to have a copy of the primary insurance company's explanation of benefits along with the claim for review.
[AGENT][NEUTRAL] And then we also have a port.
[CUSTOMER][MIXED] OK, but the plan.
[CUSTOMER][NEUTRAL] Mm
[CUSTOMER][NEUTRAL] Mhm go ahead.
[AGENT][NEUTRAL] We do have a portal in which you can check claim status once we've processed our claim and that website that you would go to is secured.
[AGENT][NEUTRAL] [PII].
[AGENT][NEUTRAL] [PII].
[CUSTOMER][NEUTRAL] OK, and that's for the status you said, um, but this plan is like it does pick up copays, deductibles or co-insurance.
[AGENT][NEUTRAL] That is what it is designed to do of covered services.
[CUSTOMER][NEUTRAL] Alrighty, Ms. [PII], could I have the initial last name and a please.
[AGENT][NEUTRAL] I can tell you.
[AGENT][NEUTRAL] Yes, ma'am.
[AGENT][NEUTRAL] Yes, it's [PII], and my name in today's date will be the call reference number.
[CUSTOMER][POSITIVE] Awesome thank you have a great rest of your day.
[AGENT][POSITIVE] Yes, ma'am, you too. And if that's all I can help you with, thank you again for calling APL and uh again, have a wonderful day.
[CUSTOMER][POSITIVE] You too thank you.
[AGENT][POSITIVE] Thank you.