AccountId: 011433970860
ContactId: d8651460-7edf-4730-b8be-7b0d3b5782da
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 227639 ms
Total Talk Time (AGENT): 85169 ms
Total Talk Time (CUSTOMER): 108133 ms
Interruptions: 0
Overall Sentiment: AGENT=0.6, CUSTOMER=0.2
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/06/06/d8651460-7edf-4730-b8be-7b0d3b5782da_20250606T12:31_UTC.wav
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[CUSTOMER][NEUTRAL] Mm
[AGENT][NEUTRAL] Thank you for calling APL. This is [PII]. How can I help you?
[CUSTOMER][NEUTRAL] Oh
[CUSTOMER][NEUTRAL] Hello, my name is [PII], and the initial of my last name is [PII]. I'm just, uh, calling to verify the the benefits for a middle patient, please.
[AGENT][POSITIVE] I'm sure, [PII], I can assist you with benefits and first I'll need a good callback number just in case we're disconnected.
[CUSTOMER][NEUTRAL] OK, [PII].
[AGENT][NEUTRAL] Thank you. Now I need the policy number, please.
[CUSTOMER][NEUTRAL] It's 02579413.
[AGENT][NEUTRAL] And please verify the patient's name and date of birth.
[CUSTOMER][NEUTRAL] [PII] or [PII].
[AGENT][NEUTRAL] And the date of birth, please?
[CUSTOMER][NEUTRAL] For [PII], [PII] I'm sorry, [PII].
[AGENT][NEUTRAL] And just submit advise you the verification of coverage does not guarantee payment of claims. Um, the effective date on this policy was [PII], and the policy is still active. Um, is this for inpatient or outpatient benefits or an office visit?
[CUSTOMER][NEUTRAL] Yeah
[CUSTOMER][NEUTRAL] But.
[CUSTOMER][NEUTRAL] Upgrades.
[CUSTOMER][NEUTRAL] Yes, outpatient benefits, uh, and some of uh the all of them at the specialist office.
[CUSTOMER][NEUTRAL] But uh I see that this patient has a primary that is Florida Blue, so I just wanna uh know if um you have an additional benefit for this patient or is uh 80/20 or you follow the guidelines. I want to know how, how it works.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] Um, yes, this is secondary gap insurance. What we do is cover the co-insurance and the deductible. After the primary insurance processes the claim for office visits. Um, we don't cover the co-pay. Again, we only cover the co-insurance and the deductible, and we cover that up to $500 per day.
[CUSTOMER][NEUTRAL] $500 per day.
[AGENT][NEUTRAL] Yes, sir.
[CUSTOMER][NEUTRAL] So if the patient do a surgery that costs $500 you'll cover in full.
[AGENT][NEUTRAL] If the charges go to the co-insurance and the deductible after the primary insurance processes claim, yes, sir, we cover up to 500.
[CUSTOMER][NEUTRAL] OK, so, basically you follow the guidelines of the.
[CUSTOMER][NEUTRAL] Of the primary.
[AGENT][POSITIVE] Yes, we do.
[CUSTOMER][NEUTRAL] Right.
[AGENT][NEUTRAL] Yes.
[AGENT][NEUTRAL] OK
[CUSTOMER][NEUTRAL] OK, give me 1 2nd.
[AGENT][NEUTRAL] Sure.
[CUSTOMER][NEUTRAL] No, uh.
[CUSTOMER][NEUTRAL] Give me 1 2nd please.
[CUSTOMER][NEUTRAL] Now may I have your name and the reference number for this call and that's it, please?
[CUSTOMER][NEUTRAL] Yeah.
[AGENT][NEUTRAL] Um yes. You, uh my name is [PII]. It's spelled [PII] My last initial is [PII], and you can use my name and today's date for the reference number. Um, is there anything else I can assist you with?
[CUSTOMER][POSITIVE] Uh no, thank you so much. You were very helpful. Have a nice day.
[AGENT][NEUTRAL] You do the same, [PII]. Thank you for calling APR. Mm bye.
[CUSTOMER][NEUTRAL] Yeah
[CUSTOMER][NEUTRAL] Bye.