AccountId: 011433970860
ContactId: e10b34e4-57ef-485c-b050-963f2cc85537
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 223919 ms
Total Talk Time (AGENT): 98604 ms
Total Talk Time (CUSTOMER): 139370 ms
Interruptions: 3
Overall Sentiment: AGENT=0.6, CUSTOMER=1.7
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2024/12/30/e10b34e4-57ef-485c-b050-963f2cc85537_20241230T22:01_UTC.wav
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[AGENT][NEUTRAL] Calling APL, this is [PII]. How may I help you?
[CUSTOMER][NEUTRAL] Hi [PII], my name is [PII]. I'm calling from RANDI Institute calling in regards to mutual member. I'm calling for benefits. Thank you.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] OK, alright and so this is an office visit setting?
[CUSTOMER][NEUTRAL] No, it is not. This is for an outpatient procedure being performed in a free standing ambulatory.
[AGENT][NEUTRAL] Oh
[AGENT][NEUTRAL] OK, got it. And what's the policy number, [PII]?
[CUSTOMER][NEUTRAL] Policy number is 10 0 I apologize, I'm giving you the sign as the primary. OK, the American Public Life is 02458027 M as in Mary, L as in Larry, the number 8.
[AGENT][NEUTRAL] OK.
[AGENT][POSITIVE] OK, thank you and what's a good callback number in case we're disconnected?
[CUSTOMER][NEUTRAL] Sure, it's [PII].
[AGENT][NEUTRAL] OK, thank you, and the patient's name and date of birth?
[CUSTOMER][POSITIVE] Thank you.
[CUSTOMER][NEUTRAL] It's [PII]. Date of birth is [PII].
[AGENT][NEUTRAL] Thank you for verifying that information for me, [PII]. So we're checking eligibility and then outpatient facility, correct?
[CUSTOMER][POSITIVE] Yeah my pleasure.
[CUSTOMER][NEUTRAL] Correct, right. What I'm looking for is benefits and eligibility for outpatient surgery being performed in the freestanding ambulatory. This is the gap policy, correct?
[AGENT][NEUTRAL] All right, so
[AGENT][NEUTRAL] Mhm.
[AGENT][NEUTRAL] Correct, so I'm showing the effective date of [PII], the policy is active at this time, and the maximum outpatient benefit is up to $2250 that is per calendar here and the information provided is verification, not a guarantee of benefits and currently of that amount.
[CUSTOMER][NEUTRAL] Yeah, that's what I
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Per year. OK.
[AGENT][NEUTRAL] Let's see.
[AGENT][NEUTRAL] One moment.
[CUSTOMER][POSITIVE] Thank you.
[AGENT][NEUTRAL] Of that amount, it looks like we've already paid $2,178.50 of the maximum.
[CUSTOMER][NEUTRAL] OK, so they only, I don't have much left. The difference between those two, I don't have my calculator. Does it tell you how much is remaining?
[AGENT][NEUTRAL] I don't have a calculator either, so it's 2250.
[CUSTOMER][NEUTRAL] OK, alright, 2250 minus 2178.5 correct?
[AGENT][NEUTRAL] 2250 is the benefit.
[CUSTOMER][NEUTRAL] Right, right. And they do.
[AGENT][NEUTRAL] What's been paid is 2,178.50.
[CUSTOMER][NEUTRAL] Correct, so 2250 minus the 2178.5, so they have $71.50 remaining as of right now.
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Is that correct? OK, and can that be utilized towards like um towards the deductible with Cigna or towards a copay?
[AGENT][NEUTRAL] At this time.
[AGENT][NEUTRAL] So because this is secondary, this policy will um cover, cover charges applied towards deductible co-insurance and or co-pay amounts. That is correct.
[CUSTOMER][NEUTRAL] Mm
[CUSTOMER][NEUTRAL] OK, so, OK, co-pay, co-insurance or deductible, perfect. Well, it's only 7150 going towards it, but it's better than nothing. OK, and that's as of today. I, I realized there could be another claim out there that hasn't been processed, right, but as of this moment with us speaking 7150. OK, and if I could please just get a reference number from you, I'd appreciate it. Thank you, [PII].
[AGENT][POSITIVE] Correct.
[AGENT][NEUTRAL] As of this moment. Mhm.
[AGENT][NEUTRAL] Mhm.
[AGENT][NEUTRAL] Of course, you'll use my name in today's date as your reference. [PII], first initial [PII], and did you have any other questions?
[CUSTOMER][NEUTRAL] ONYA yeah, OK.
[CUSTOMER][POSITIVE] Perfect.
[CUSTOMER][POSITIVE] Nothing else, but I thank you so very much and I wish you a very happy and healthy New [PII].
[AGENT][POSITIVE] Same to you thanks for calling APL have a good day.
[CUSTOMER][POSITIVE] Thank you. Thanks. Bye bye.