AccountId: 011433970860
ContactId: e143111c-b59b-4ab0-8133-725c3f1cf9ca
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 310980 ms
Total Talk Time (AGENT): 138098 ms
Total Talk Time (CUSTOMER): 108779 ms
Interruptions: 0
Overall Sentiment: AGENT=0.8, CUSTOMER=0.4
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/06/23/e143111c-b59b-4ab0-8133-725c3f1cf9ca_20250623T15:27_UTC.wav
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[AGENT][POSITIVE] Good morning. Thank you for calling APL. This is [PII]. May I help you?
[CUSTOMER][NEUTRAL] Hi, how are you? What is your name?
[AGENT][NEUTRAL] It's [PII]
[CUSTOMER][NEUTRAL] [PII], what is the initial of your last name?
[AGENT][NEUTRAL] [PII].
[CUSTOMER][NEUTRAL] I'm [PII] and my initial is [PII]
[AGENT][NEUTRAL] OK, Ms. [PII], how may I assist you today?
[CUSTOMER][NEUTRAL] I just wanted to verify benefits on this patient.
[AGENT][NEUTRAL] OK, I can verify benefits for you. Um, what's that policy number, please?
[CUSTOMER][NEUTRAL] It is 023-37082 M like Mary, L like Larry, 7.
[AGENT][NEUTRAL] OK, thank you. And do you have a callback number in case the call drops?
[CUSTOMER][NEUTRAL] [PII]
[AGENT][NEUTRAL] OK. And the patient's name, date of birth?
[CUSTOMER][NEUTRAL] Patient's name is [PII], and the date of birth is [PII].
[AGENT][NEUTRAL] OK, I'm showing his effective date is [PII]. He is active under the policy.
[AGENT][NEUTRAL] And what benefits are you needing for this patient?
[CUSTOMER][NEUTRAL] Uh, co-pays for the ER deductibles if they're met they if they if the secondary picks it up.
[AGENT][NEUTRAL] OK, not a guarantee of payment, just a verification of coverage. I do show they do, um, with this policy is secondary, it helps with primary deductible, co-pay or co-insurance, and they have a benefit max up to 1000 per calendar year. However, they do have an ER deductible up to 500 per occurrence.
[CUSTOMER][NEUTRAL] Which means they would be responsible for.
[CUSTOMER][NEUTRAL] Um, that, that deductible at the copay, I mean at the ER.
[AGENT][NEUTRAL] Yes, ma'am. So after they've reached their ER deductible, then we pay up to that $1000 for outpatient benefits.
[CUSTOMER][NEUTRAL] So they have $500.
[CUSTOMER][NEUTRAL] For the ER.
[AGENT][NEUTRAL] Uh, yes, ma'am.
[CUSTOMER][NEUTRAL] Co-pay.
[AGENT][NEUTRAL] Deductible. They have a $500 deductible.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][MIXED] OK, deductible.
[CUSTOMER][NEUTRAL] OK, so then if they have a $350 for their regular insurance which is AMed for their co-pay, you would not pay that until that $500 is met.
[AGENT][POSITIVE] Correct.
[CUSTOMER][NEUTRAL] Which means that total would be 850, correct?
[AGENT][NEUTRAL] No, not really. Like the amount that the primary applied for is either deductible, co-pay, or co-insurance. That's what we would typically pick up even uh but they have the deductible, so that benefit amount would have went towards that $500 deductible. So any balance remaining then be patient responsibility.
[CUSTOMER][NEUTRAL] But that's what I'm saying, did they meet the $500 deductible?
[AGENT][NEUTRAL] No, ma'am, it's a per occurrence deductible. It's not per calendar year.
[CUSTOMER][NEUTRAL] It's per occurrence.
[AGENT][NEUTRAL] Yes, ma'am.
[CUSTOMER][NEUTRAL] OK, so then they would be responsible here for the ER $500.
[AGENT][NEUTRAL] Whatever they have for the primary after they have processed the claim but then probably be their uh responsibility since they had met the $500 deductible with us.
[CUSTOMER][NEGATIVE] Not understanding. I'm sorry.
[AGENT][NEUTRAL] OK, with the policy is secondary, say for instance they didn't have a deductible with us.
[AGENT][NEUTRAL] What we will pick up as secondary is what primary applies towards deductible, co-pay or co-insurance. Since that person does have a deductible, whatever benefit amount that could have been payable will go towards that $500 deductible for that occurrence. Once that deductible has been reached, then we can pay up to the $1000 benefit.
[CUSTOMER][NEUTRAL] OK, so then for the regular, I wanna be able to understand this for the regular insurance which they have AMed, they have a $350 co-payment for the ER.
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] They would, they would be responsible for that and that goes towards the $500 on the 2nd.
[AGENT][POSITIVE] Correct.
[CUSTOMER][NEUTRAL] OK, alright, that's what I wanted to know.
[CUSTOMER][NEUTRAL] Do I have a um reference for this call?
[AGENT][NEUTRAL] Uh, if you like, you may use my name at today's date.
[CUSTOMER][POSITIVE] OK, [PII], thank you so much.
[AGENT][POSITIVE] Uh, yes, ma'am. Thanks for calling APM Ms. [PII]. Bye.
[CUSTOMER][POSITIVE] Bye bye thank you bye.