AccountId: 011433970860
ContactId: dd61243e-382f-43fa-b9a1-c2fcd275dbca
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 201860 ms
Total Talk Time (AGENT): 120145 ms
Total Talk Time (CUSTOMER): 66116 ms
Interruptions: 2
Overall Sentiment: AGENT=0.3, CUSTOMER=0.6
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/02/06/dd61243e-382f-43fa-b9a1-c2fcd275dbca_20250206T21:12_UTC.wav
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[AGENT][NEUTRAL] Thank you for calling APL. You're speaking with [PII]. How may I help you today?
[CUSTOMER][POSITIVE] Hey, um, I'm calling to get benefits for a patient.
[AGENT][NEUTRAL] All right. May I have your name?
[CUSTOMER][NEUTRAL] My first name is [PII]. My last initial is [PII] like cat.
[AGENT][NEUTRAL] All right. And can I have that phone number just in case we get disconnected?
[CUSTOMER][NEUTRAL] [PII]
[AGENT][NEUTRAL] And what's the name of the providers that you're calling from?
[CUSTOMER][NEUTRAL] Um, I am calling from, uh, the American Health Imaging.
[AGENT][NEUTRAL] All right. May I have that policy number, OK?
[CUSTOMER][NEUTRAL] Yes, um, OK, it's gonna be.
[CUSTOMER][NEUTRAL] 01587406
[AGENT][NEUTRAL] And the patient name and date of birth?
[CUSTOMER][NEUTRAL] I have a [PII] [PII].
[AGENT][NEUTRAL] All right, thank you for that information. You're calling for eligibility on this patient?
[CUSTOMER][NEUTRAL] Yes, ma'am.
[AGENT][NEUTRAL] All right, his policy effective date was [PII]. It is still an active policy. He is the primary holder of this policy, and this is the patient's secondary policy.
[CUSTOMER][NEUTRAL] Mm.
[CUSTOMER][NEUTRAL] Yes ma'am, um, can I have like, are there any like, well, is there an individual deductible and out of pocket or coin insurance?
[AGENT][NEUTRAL] Well, this is the patient's secondary policy, and it's only going to process and pay any benefits if the primary applies anything towards what medical treatment they have and if it's a covered benefit on our policy. Now for outpatient calendar year max is $5000 and for inpatient calendar year max is a $5000 benefit.
[AGENT][NEUTRAL] So you want an example, say he went to an image site to get an MRI done and said the provider charged that $1500 but they had an MRI and the primary insured only paid $350 the most we'll pay.
[AGENT][NEUTRAL] It's up to $350 if he still have part of his $5000 benefits per outpatient uh available at the time that claim come our office when you submit a claim, you have to submit the primary explanation of benefit along with the itemized bill.
[CUSTOMER][NEUTRAL] Yes ma'am, OK, um, alright, so you just said that his, um, calendar year is 5000 correct?
[AGENT][NEUTRAL] Per year, uh, outpatient, inpatient is also $5000.
[AGENT][NEUTRAL] And there's never any guarantee to pay over the phone. This is just a quote of coverage.
[CUSTOMER][NEUTRAL] OK, and, and I give you that.
[CUSTOMER][NEUTRAL] Yes ma'am, and, and has any of it um been used? I just need to put it in my notes for documentation.
[AGENT][NEUTRAL] I wouldn't be, I, I wouldn't be able to tell you that. You just have to submit your claim. We have claims come in daily.
[CUSTOMER][POSITIVE] OK, OK. Yes, ma'am. Thank you so much.
[AGENT][NEUTRAL] All right. All right. Anything else I can help you with today?
[CUSTOMER][NEUTRAL] Yes.
[CUSTOMER][NEUTRAL] Um, no, ma'am.
[AGENT][POSITIVE] All right. Well, thank you for calling American Public Life, and you have a wonderful afternoon. Bye-bye.
[CUSTOMER][NEUTRAL] You too bye bye.