AccountId: 011433970860
ContactId: df38f8fc-2c81-4bea-b96e-7e67bf30ffad
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 216830 ms
Total Talk Time (AGENT): 99549 ms
Total Talk Time (CUSTOMER): 95587 ms
Interruptions: 0
Overall Sentiment: AGENT=0, CUSTOMER=0.2
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/03/10/df38f8fc-2c81-4bea-b96e-7e67bf30ffad_20250310T12:57_UTC.wav
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[AGENT][NEUTRAL] APL. This is [PII]. How may I assist you?
[CUSTOMER][NEUTRAL] Yes, hi, my name is [PII]. I'm calling from um Park Creek Surgery Center. I'm calling to get benefits, please.
[AGENT][NEUTRAL] Sure, I can assist you with that. Can I have a callback number for you? You did say your name was [PII]?
[CUSTOMER][NEUTRAL] [PII]
[CUSTOMER][NEUTRAL] And my callback number is [PII].
[AGENT][NEUTRAL] [PII], thank you. Can I have that policy number of the member that you're inquiring eligibility for?
[CUSTOMER][NEUTRAL] Sure, it is 01867119 M as in Mary, L as in Lima, 8.
[AGENT][NEUTRAL] And could you verify the patient's name and date of birth?
[CUSTOMER][NEUTRAL] Um, let's see here it is, um.
[CUSTOMER][NEUTRAL] [PII]. Date of birth of [PII].
[AGENT][NEUTRAL] Thank you, Ma and, and you're calling to verify benefits for inpatient, outpatient, office visits?
[CUSTOMER][NEUTRAL] Outpatient for a um for outpatient surgery at an ambulatory surgery center, please.
[AGENT][NEUTRAL] This policy has been active since [PII] and is currently active.
[AGENT][NEUTRAL] The member has outpatient benefits?
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] Of $500 per calendar day and this is not a guaranteed benefits just a disclaimer of the policy's coverage.
[CUSTOMER][NEUTRAL] OK, and what type of policy is this?
[AGENT][NEUTRAL] This is a gap insurance that assists with deductible, co-pay and co-insurance to the primary.
[CUSTOMER][NEUTRAL] And how
[CUSTOMER][NEUTRAL] OK, so this is a gap insurance, OK, like a supple supplement policy.
[AGENT][NEUTRAL] Mhm.
[AGENT][NEUTRAL] Um, well, so this policy is, yeah, you could say that, so the policy say if they have a prime, where they have to have a primary in order to have this type of policy. So say if the primary has a deductible or co-pay amount that still do, has not been met, then whatever went towards deductible copay and co-insurance, you will submit the claim here along with the primary ELB and then we will pay whatever went towards deductible copay and co-insurance until the benefit ma.
[CUSTOMER][NEUTRAL] OK, so, so you pick up, uh, so you would pick up the primary, um, deductible and co-insurance up to your maximum.
[AGENT][NEUTRAL] Yes.
[CUSTOMER][NEUTRAL] OK, so you pick up deductible and uh uh I'm sorry, deductible and co-insurance, and what is the maximum?
[AGENT][NEUTRAL] Mhm.
[AGENT][NEGATIVE] $500 per calendar day and this is not a guaranteed benefits, just a disclaimer of the policy's coverage.
[CUSTOMER][NEUTRAL] And has the patient used any of that $500?
[AGENT][NEUTRAL] It's per calendar day, per calendar day, each day.
[CUSTOMER][NEUTRAL] Oh
[CUSTOMER][NEUTRAL] And the and this is um for outpatient right?
[AGENT][POSITIVE] Yes, that is correct.
[CUSTOMER][NEUTRAL] This is for
[CUSTOMER][NEUTRAL] Per calendar, is there any authorization required?
[AGENT][NEUTRAL] No.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] Is there anything else that I can assist you with?
[CUSTOMER][NEUTRAL] Does this patient
[CUSTOMER][NEUTRAL] Um, does this patient have a like a deductible or um.
[CUSTOMER][NEUTRAL] Co-insurance for the plan or no?
[AGENT][NEGATIVE] Not with this policy, no.
[CUSTOMER][NEUTRAL] No, OK, not with this policy, OK then and well it looks like you've answered my question. Your name again please?
[AGENT][NEUTRAL] [PII] and today's date as a reference because we don't provide reference numbers.
[CUSTOMER][POSITIVE] Alright then [PII], I wanna thank you very much for your time and patience. I appreciate it.
[AGENT][POSITIVE] You're welcome, [PII]. Thanks for calling APL. Have a great day.
[CUSTOMER][NEUTRAL] You as well bye now.
[AGENT][NEUTRAL] OK.