AccountId: 011433970860
ContactId: dfb765e5-770e-4c42-8554-b2ab78608a46
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 241880 ms
Total Talk Time (AGENT): 119361 ms
Total Talk Time (CUSTOMER): 88667 ms
Interruptions: 1
Overall Sentiment: AGENT=1.2, CUSTOMER=0.5
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/02/13/dfb765e5-770e-4c42-8554-b2ab78608a46_20250213T15:25_UTC.wav
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[AGENT][POSITIVE] Good morning. Thank you for calling APL. My name is [PII]. How may I help you?
[CUSTOMER][NEUTRAL] Yes ma'am I'm just trying to see if you all are in network with our company um.
[CUSTOMER][NEUTRAL] I received some information from one of our patients and we're just trying to check and see.
[AGENT][POSITIVE] OK. Um, well, I can definitely help you with the eligibility. May I have your name and a good contact number in case we're disconnected?
[CUSTOMER][NEUTRAL] My name is [PII]. Last initial is [PII] Uh the contact number is [PII], sorry.
[AGENT][NEUTRAL] Oh, that's OK. And [PII], may I have the member's policy number?
[CUSTOMER][NEUTRAL] Looks like the policy number is going to be um one, no, let me see, policy number right here. OK. uh 01947017.
[AGENT][NEUTRAL] Thank you, hold on one moment.
[AGENT][NEUTRAL] And can you verify the member's first and last name and date of birth?
[CUSTOMER][NEUTRAL] Uh, first name [PII], last name [PII]. Date of birth is going to be, one second, let me put it up on my system.
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Date of birth is gonna be [PII].
[AGENT][NEUTRAL] Thank you for that and all the information provided is a verification of benefits, not a guarantee of payment. So, I'm showing that this is the um meddling policy. So it's a supplemental policy, so there's no network. Um, we apply to the co-pay, deductible and co-insurance after primary.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] And their primary is listed as United Healthcare. So our policy goes second to United Healthcare.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] A secondary.
[AGENT][NEUTRAL] Right.
[CUSTOMER][NEUTRAL] So
[CUSTOMER][NEUTRAL] OK, and um mm what you saying that so I wouldn't be able to see what you said it's afterwards.
[CUSTOMER][NEUTRAL] As far as like the deductible and out of pocket things like that, correct?
[AGENT][NEUTRAL] So, we help pay um the deductible, but I can, our policy does have its own benefits. Um, are you wanting to know the benefits for this policy?
[CUSTOMER][NEUTRAL] Because she hasn't met yet.
[CUSTOMER][NEUTRAL] Yeah, she hasn't made anything with the United Healthcare at the moment.
[AGENT][NEUTRAL] OK, so depending on what.
[CUSTOMER][NEGATIVE] Literally nothing.
[AGENT][NEUTRAL] What's being done, um, we pay towards the, I mean, she would still have to pay upfront. It depends on the type of facility. If it's something that can be billed, we'll handle it on the back end. If she has to be, you know, pay that to be seen, then she'll have to pay that upfront and then um could possibly be reimbursed on the back end. Are you all considered outpatient or this is going to be an inpatient procedure? OK.
[CUSTOMER][NEUTRAL] OK, uh huh.
[CUSTOMER][NEUTRAL] Yes. No, outpatient.
[AGENT][NEUTRAL] So the policy for outpatient will pay up to $5000 per calendar year.
[AGENT][NEUTRAL] There is a $250 deductible for this policy as well.
[CUSTOMER][NEUTRAL] $250.
[AGENT][NEUTRAL] Mhm.
[AGENT][NEUTRAL] Well, actually, hold on one moment.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] OK, accident and sickness. OK, yes, I just want to make sure. So yes, it is a $250 deductible.
[CUSTOMER][NEUTRAL] OK, I got that down.
[AGENT][NEUTRAL] And again, just for the call, all the information provided is a verification of benefits, not a guarantee of payment. What were you saying?
[CUSTOMER][POSITIVE] Just like what you be doing OK.
[CUSTOMER][NEUTRAL] Uh, nothing. I was just writing it down.
[AGENT][NEUTRAL] Oh, OK. I thought you had another question, sorry.
[CUSTOMER][NEUTRAL] Uh, yes, can I get your name?
[AGENT][NEUTRAL] Sure, my name is [PII]
[CUSTOMER][NEUTRAL] Last initial?
[AGENT][NEUTRAL] Is [PII].
[CUSTOMER][NEUTRAL] OK, and a reference number for this call?
[AGENT][NEUTRAL] So there's no call reference number, but you can use my name in today's date.
[CUSTOMER][POSITIVE] OK, sounds great thank you so much, [PII].
[AGENT][POSITIVE] You're very welcome and thanks for calling APL. I hope you have a good day.
[CUSTOMER][POSITIVE] You as well thank you.
[AGENT][POSITIVE] You're welcome