AccountId: 011433970860
ContactId: db62ec5a-cb0d-4e35-be4b-184f8b93e760
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 209449 ms
Total Talk Time (AGENT): 91761 ms
Total Talk Time (CUSTOMER): 101581 ms
Interruptions: 1
Overall Sentiment: AGENT=1.1, CUSTOMER=2.5
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/01/08/db62ec5a-cb0d-4e35-be4b-184f8b93e760_20250108T21:59_UTC.wav
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[AGENT][NEUTRAL] Thank you for calling APL. This is [PII]. How can I help you?
[CUSTOMER][POSITIVE] Hello my [PII], how are you dear? This is [PII] in customer service.
[AGENT][POSITIVE] I'm good, [PII], yes, how are you?
[CUSTOMER][NEUTRAL] I'm fine, thank you, ma'am. Miss [PII], I have policy number 2501627.
[AGENT][NEUTRAL] Yeah.
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK, and I have the provider on the phone. His name is [PII].
[AGENT][NEUTRAL] [PII], OK, thank you.
[CUSTOMER][NEUTRAL] And he just wanted, you know, I did verify the date of birth and address with him, um, now he just wanted to make sure the policy was active or not. I did let him know it was active and then he started asking me benefit questions and I'm like going, uh, I don't know.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] Yeah
[AGENT][POSITIVE] OK. I can help him. Thank you, [PII]. I appreciate it.
[CUSTOMER][POSITIVE] Thank you, dear. Bye.
[AGENT][NEUTRAL] Bye bye.
[AGENT][NEUTRAL] Thank you for calling APL. This is [PII]. How can I help you?
[CUSTOMER][NEUTRAL] Yes, hello. My name is [PII]. I'm calling from Baptist Hospital in [PII]. Um, I was just looking uh to see if you could assist me with uh the benefits for a gap insurance policy for a patient.
[AGENT][NEUTRAL] Of course, I sure can. I, I was, I already provided the policy number and the patient's name, and would this be for inpatient or outpatient?
[CUSTOMER][NEUTRAL] Outpatient.
[AGENT][NEUTRAL] OK, I can assist with that. Give me a moment please.
[CUSTOMER][POSITIVE] All right, thank you.
[AGENT][NEUTRAL] You're welcome. Now would this be for an office setting or a facility charge?
[CUSTOMER][NEUTRAL] Uh, it would be for a hospital setting.
[AGENT][NEUTRAL] OK, thank you so much. Please note verification of benefits provided does not guarantee payment. We pay up to $5000 for the calendar year for covered outpatient services.
[CUSTOMER][NEUTRAL] OK. Yeah. So all I need to know actually is just um
[CUSTOMER][NEUTRAL] No, actually, let me take a look here one sec.
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] So, um, yeah, I'm I'm relatively new at this job, so it's the first time actually calling uh American uh Pub Life. So do you guys actually have like specific benefits as far as like uh like a benefit for, for chemotherapy, benefit for uh
[CUSTOMER][NEUTRAL] MRIs and that kind of thing? Is that how it works with the gap insurance?
[AGENT][NEUTRAL] With the gap, well, I'm sorry, with the supplemental or gap insurance, we pay based on coverage, um, with this particular patient, um, he has both inpatient and outpatient benefits, um, for, of course, coverage services we pay up to $5000 and as the gap insurance we help with the major medicals deductible, co-pay and or co-insurance based on coverage, of course, and we pay up to $5000.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK. And are you able to see if this patient has used any of that 5000 for this year yet?
[AGENT][NEUTRAL] Sure, I can check that for you and no, the number has not.
[CUSTOMER][NEUTRAL] OK, perfect. I'll go ahead and notate that here. So 0 out of 5000. All right, and it's still the same uh policy number and everything, right? The one you were provided?
[AGENT][NEUTRAL] Yes, that is correct. And just to verify that I have 02501627.
[CUSTOMER][POSITIVE] Correct.
[AGENT][NEUTRAL] OK, would you need any information as far as claim submission or mailing address, payer ID, fax number?
[CUSTOMER][POSITIVE] Uh, no, should be, should be good. If anything else, I'll just give you guys a ring back.
[AGENT][NEUTRAL] OK.
[AGENT][POSITIVE] Alright, well thank you. Anything else I can help you with [PII]?
[CUSTOMER][POSITIVE] Uh, that'll be it. Thank you so much.
[AGENT][POSITIVE] You're welcome and thank you for calling APL. Have a great day, bye.
[CUSTOMER][POSITIVE] All right you too.