AccountId: 011433970860
ContactId: e22a1ef9-a031-4171-affc-39788fb05d18
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 295690 ms
Total Talk Time (AGENT): 136126 ms
Total Talk Time (CUSTOMER): 134924 ms
Interruptions: 0
Overall Sentiment: AGENT=1.7, CUSTOMER=0.4
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/01/27/e22a1ef9-a031-4171-affc-39788fb05d18_20250127T21:51_UTC.wav
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[AGENT][NEUTRAL] Thank you for calling APL. This is [PII] speaking. How may I help you?
[CUSTOMER][NEUTRAL] Yes, my name is [PII] and I'm at Hillcrest Medical Center and I'm trying to um get benefits for a patient. Uh, he came in and he has this um these health benefits as a secondary it looks like, um, and I'm at Hillcrest Medical Center and tell me your name again.
[AGENT][NEUTRAL] OK.
[AGENT][POSITIVE] It's [PII] My last initial [PII].
[CUSTOMER][POSITIVE] OK, thank you.
[AGENT][POSITIVE] You're welcome [PII], and can I have a callback number for you, [PII] in case we get disconnected?
[CUSTOMER][NEUTRAL] I'm OK. I'm at [PII] and that's my direct extension.
[AGENT][POSITIVE] Thank you, and I'll be happy to help you with those benefits that, do you have the policy number or member ID please?
[CUSTOMER][NEUTRAL] Yes, I do. It's 02566560.
[AGENT][POSITIVE] Thank you, and just give me one moment while I pull up that policy.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] And may I please have you verify the patient's name and date of birth?
[CUSTOMER][NEUTRAL] [PII], it's [PII].
[AGENT][POSITIVE] Thank you.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] Just to let you know, [PII], this is a verification of coverage only, not a guarantee of payment. The policy is active.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] And [PII], let's see what the effective thing if there was a previous policy.
[AGENT][NEUTRAL] Um, OK, so the policy effective date is [PII] for this policy. He did have prior coverage, um, under a different policy number, but it's been continuous, but this is still active.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] It is a supplemental, uh, limited, uh, medical supplemental benefit expense. So it does work hand in hand with his major medical.
[AGENT][NEUTRAL] And this policy will work to cover co-insurance and or deductible amounts for services that are covered under the plan. And did you say he came to the emergency room?
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] No, we're at, uh, at Hillcrest Hospital or out uh outpatient, but we're a diabetes, um, management center, and so he's here, um, for that for diabetes self management training, nutrition therapy, and continuous glucose monitoring.
[AGENT][NEUTRAL] Oh.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] OK
[AGENT][NEUTRAL] So, um.
[AGENT][NEUTRAL] Let me just
[CUSTOMER][NEUTRAL] So we would bill as Blue Cross first and then this is just it works like a supplemental um policy and so after it was billed to Blue Cross it would directly go to APL.
[AGENT][NEUTRAL] Mhm.
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] And then um.
[CUSTOMER][NEUTRAL] And then I guess if you know if he has coverage for um deductible and co-insurance um then that that should cover it.
[AGENT][NEUTRAL] Right.
[AGENT][NEUTRAL] OK. And let me just, so this would be kind of like um he will be face to face with the physician?
[CUSTOMER][NEUTRAL] Uh, well, not a physician. It is, uh, it's a diabetes educator and we are certified, um, with the AA. I always get it mixed up. It's the, um, diabetes Association.
[AGENT][NEUTRAL] Is that right?
[AGENT][NEUTRAL] Association OK.
[CUSTOMER][NEUTRAL] Mhm, uh, we do all of the things that they ask of us, so we have a yearly, you know, deal to stay accredited with them.
[AGENT][NEUTRAL] OK
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] So that outpatient benefit under this plan, um, [PII], it has a $3000 per covered person per calendar year.
[AGENT][NEUTRAL] And again that's for the services that are covered under the plan. The primary insurance would need to pay in order for this policy to pay.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] Um, and I don't show any claims for [PII], so he does have that $3000 benefit available as of today.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] Did you have any other questions?
[CUSTOMER][NEUTRAL] No I guess not, um, and then, uh, do you use the call reference number?
[AGENT][NEUTRAL] Certainly the call reference number [PII] would be my name in today's date and again it's [PII] last initial [PII]
[CUSTOMER][NEUTRAL] Oh, OK.
[CUSTOMER][POSITIVE] OK, thank you very much I really appreciate your help.
[AGENT][POSITIVE] You're welcome [PII]. Thank you so much for calling APL. I hope you have a great rest of your day.
[CUSTOMER][NEUTRAL] You too bye bye.
[AGENT][POSITIVE] Thank you bye bye.