AccountId: 011433970860
ContactId: e06fa4c8-a385-4a88-b8cb-038405cbe502
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 248630 ms
Total Talk Time (AGENT): 95828 ms
Total Talk Time (CUSTOMER): 114333 ms
Interruptions: 0
Overall Sentiment: AGENT=0.2, CUSTOMER=0.3
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/06/26/e06fa4c8-a385-4a88-b8cb-038405cbe502_20250626T15:22_UTC.wav
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[CUSTOMER][NEUTRAL] I
[AGENT][POSITIVE] Good morning. Thank you for calling APL. This is Ki[PII]May I help you?
[CUSTOMER][NEUTRAL] Uh, good morning. I was calling to get benefits on a patient and to see how you guys, um, like.
[CUSTOMER][NEUTRAL] Work out in between her primary for global maternity.
[AGENT][NEUTRAL] OK, I can verify benefits for you. And your name is?
[CUSTOMER][POSITIVE] Thanks.
[CUSTOMER][NEUTRAL] Re[PII]
[AGENT][NEUTRAL] [PII]K, and Ms. Re[PII]what is the policy number, please?
[CUSTOMER][NEUTRAL] Um, I have it as 018286778.
[CUSTOMER][NEUTRAL] M [PII]umber 7.
[CUSTOMER][NEUTRAL] Da[PII].
[AGENT][NEUTRAL] OK. And the date of birth?
[CUSTOMER][NEUTRAL] Fe[PII].
[AGENT][NEUTRAL] OK, thank you. And do you have a callback number in case the call drops?
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Yeah, 81[PII].
[AGENT][NEUTRAL] OK, thank you. And so you wanting benefits for maternity?
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Yeah, global maternity for the professional for the inpatient side.
[CUSTOMER][NEUTRAL] And I know you guys are her secondary insurance if that's what I'm looking at correctly?
[AGENT][NEUTRAL] Yes, ma'am. Uh, with a policy that helps with secondary, uh, with primary insurance deductible, co-pay and or co-insurance, um,
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] But as far as global, it doesn't cover like for the office visits.
[AGENT][NEUTRAL] It does have benefits for outpatient like if she was to have a sonogram or diagnostic, that's covered as outpatient if performed in an outpatient facility.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Um,
[AGENT][NEUTRAL] And as far as the actual delivery.
[CUSTOMER][NEUTRAL] What about in the office setting?
[AGENT][NEGATIVE] Uh, it wouldn't be covered. They don't have a writer that covers any treatment in the office.
[CUSTOMER][NEUTRAL] What if the al
[CUSTOMER][NEUTRAL] Oh, so it's only for outpatient? OK. Outpatient for ultrasounds only.
[CUSTOMER][NEUTRAL] Ons only. Now, what did you say about the delivery portion in the hospital for inpatient, for professional?
[AGENT][NEUTRAL] Uh, that would just go towards the inpatient benefits.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] Um, not a guarantee of payment, just a verification, um, she has a benefit max up to 5000 per calendar year.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] What is the benefit Max need?
[AGENT][NEUTRAL] The max that we will pay.
[CUSTOMER][NEUTRAL] Oh, OK.
[CUSTOMER][NEUTRAL] But does she have to pay anything towards that before you cover the 5000?
[AGENT][NEUTRAL] No, ma'am. So after primary, after she's delivering primary is processed the claim, then we will need the primary ELB showing what was applied towards deductible, co-pay or co-insurance, and that's what we pick up and pay up to that $5000 benefit for the inpatient.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] OK, so if when I verify her primary benefit and let's say she has to pay $3000 towards that, you guys will automatically pay once the claim is sent over so we don't technically need to collect anything unless it's under, unless it's over 5000.
[AGENT][NEUTRAL] Right.
[CUSTOMER][NEUTRAL] Is that what I'm, OK, got you. Insurance pays 5000 once I.
[CUSTOMER][NEUTRAL] OK. And no benefit for ultrasounds done in office only for outpatient.
[AGENT][NEUTRAL] Uh, yes, ma'am.
[CUSTOMER][NEUTRAL] OK, that was all I needed. Do you, do you provide call um name and reference numbers?
[AGENT][NEUTRAL] Uh, you can use my name at today's date as reference.
[CUSTOMER][NEUTRAL] And what was your name? I'm sorry.
[AGENT][NEUTRAL] It's Ki[PII]last initial Q.
[CUSTOMER][NEUTRAL] OK, and then today's date you said?
[AGENT][NEUTRAL] Yes, ma'am.
[CUSTOMER][POSITIVE] OK. Thank you so much. I appreciate your time.
[AGENT][POSITIVE] Alright, you're welcome and thanks for calling APL. Have a great day.
[CUSTOMER][NEUTRAL] Bye bye, bye bye.
[AGENT][NEUTRAL] Bye.