AccountId: 011433970860
ContactId: e44d5f15-85da-4f90-8cfb-56e48330a57c
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 238770 ms
Total Talk Time (AGENT): 96738 ms
Total Talk Time (CUSTOMER): 99267 ms
Interruptions: 0
Overall Sentiment: AGENT=1, CUSTOMER=0.4
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/02/25/e44d5f15-85da-4f90-8cfb-56e48330a57c_20250225T22:56_UTC.wav
--------------------------------------------
[AGENT][NEUTRAL] Thank you for calling APL. This is [PII]. How can I help you?
[CUSTOMER][NEUTRAL] Hi, good afternoon. You said your name was [PII]?
[AGENT][NEUTRAL] Uh, [PII].
[CUSTOMER][POSITIVE] Oh, I'm sorry, [PII]. I apologize.
[AGENT][NEUTRAL] That's OK.
[AGENT][POSITIVE] That's right.
[CUSTOMER][NEUTRAL] And the initial of your last name?
[AGENT][NEUTRAL] It's [PII]
[CUSTOMER][NEUTRAL] Oh, OK. Hi, my name is [PII], and uh the initial, my last name is [PII] I'm calling from the provider's office. It's called [PII], and, uh, do you need an MPR or tax ID for that?
[AGENT][NEUTRAL] Um, no, we, uh, what do you need to check on a claim.
[CUSTOMER][NEUTRAL] Uh, well, no, just to, um, verify benefits.
[AGENT][NEUTRAL] Sure, yeah, I can look at those benefits for you. uh, [PII], can I get a good call back number from you first in case we're disconnected?
[CUSTOMER][NEUTRAL] Of course [PII].
[AGENT][NEUTRAL] Thank you. And then do you have the policy number?
[CUSTOMER][NEUTRAL] I do it's gonna be let me let me see here.
[CUSTOMER][NEUTRAL] OK, I believe so so it's 02548739.
[AGENT][NEUTRAL] OK, and what was the name and date of birth for the insured?
[CUSTOMER][NEUTRAL] Uh yes, it's gonna be for [PII]. The last name is [PII] and her date of birth is [PII].
[AGENT][NEUTRAL] Perfect, thank you for verifying that one. So this policy is active. Effective date was [PII], and this is a secondary medical policy, so it is designed to help with co-pay, deductible and co-insurance after major medical pays, and we we needing to look at the uh the outpatient benefits?
[CUSTOMER][NEUTRAL] Um, yes, let me just double check right here. I'm sorry.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] Oh, you're fine.
[CUSTOMER][NEUTRAL] Um, let me see here.
[AGENT][NEUTRAL] I could give you both inpatient and outpatient if you.
[AGENT][POSITIVE] That's easier.
[CUSTOMER][NEUTRAL] Let me just double check.
[CUSTOMER][NEUTRAL] Yeah and if it doesn't work, yeah.
[CUSTOMER][NEUTRAL] Let me just see something here. I apologize.
[AGENT][NEUTRAL] Oh you're fine.
[CUSTOMER][NEUTRAL] 3.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] So let's see.
[CUSTOMER][NEUTRAL] OK, so yeah, basically just to verify if you guys cover like her deductible or the copay from the primary insurance from United Healthcare, it'd be like an urgent care clinic.
[AGENT][NEUTRAL] Yeah, so this policy, um, as it's secondary medical, it is designed to help with co-pay, deductible and co-insurance after major medical pays so it can't be used instead of major medical. it is very dependent on them, uh, paying first.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Oh OK, so then does that mean, sorry, just to understand, um, so then does she have to like make a copay from the primary medical insurance?
[AGENT][NEUTRAL] Mhm.
[AGENT][NEUTRAL] No, you're fine.
[AGENT][NEUTRAL] No, so this, um, let's see, of course I will let you know verification of coverage is not a guarantee of payment for claims, um, so their outpatient benefit is on a per calendar day basis, so it pays up to $300 per calendar day and that goes towards uh co-pay, deductible and co-insurance.
[CUSTOMER][NEUTRAL] Or
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Oh, OK, that's the out of pocket benefit, correct, the $300?
[AGENT][NEUTRAL] Mhm.
[AGENT][NEUTRAL] Right.
[CUSTOMER][NEUTRAL] Oh got you OK perfect alrighty and um just the reference number for this call is your name and today's date.
[AGENT][NEUTRAL] Uh, my first name, last initial, and today's date, yes, and was there anything else I can help you with, [PII]?
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][POSITIVE] No, that is it thank you so much for your help.
[AGENT][POSITIVE] Alright, yeah, thanks for calling [PII]. I hope you have a great rest of your day.
[CUSTOMER][NEUTRAL] You too bye.
[AGENT][POSITIVE] Thank you bye bye.