AccountId: 011433970860
ContactId: e6b66cf7-5bf4-4722-8c20-1f042bdc8473
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 228830 ms
Total Talk Time (AGENT): 109216 ms
Total Talk Time (CUSTOMER): 48490 ms
Interruptions: 0
Overall Sentiment: AGENT=1.2, CUSTOMER=1.2
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/05/28/e6b66cf7-5bf4-4722-8c20-1f042bdc8473_20250528T19:06_UTC.wav
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[AGENT][NEUTRAL] Thank you for calling APL. This is [PII]. How can I help you?
[CUSTOMER][NEUTRAL] Hi [PII], uh, my name is [PII]. I was calling to check benefits for one of our patients coming in.
[AGENT][POSITIVE] I can help you with benefits, [PII]. Can I get a good uh callback number in case we get disconnected?
[CUSTOMER][NEUTRAL] Yes, it's [PII].
[AGENT][POSITIVE] OK, thank you so much. And uh what's the name of the provider you're calling from?
[CUSTOMER][NEUTRAL] Mount Sinai Medical Center.
[AGENT][NEUTRAL] OK
[AGENT][NEUTRAL] And do you have the policy number?
[CUSTOMER][NEUTRAL] Yes, it's uh 02123561.
[AGENT][NEUTRAL] One moment while I look that up.
[AGENT][NEUTRAL] Can you verify the patient's name and date of birth?
[CUSTOMER][NEUTRAL] [PII], and the date of birth is [PII].
[AGENT][POSITIVE] OK, thank you so much.
[CUSTOMER][NEUTRAL] Sure.
[AGENT][NEUTRAL] Alright, [PII], I show that this policy is active with an effective date of [PII]. It is a medling policy, so it is secondary gap insurance, so they will need to file with major medical first. Um, is there any specific benefit you are needing information on?
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Yes, so she's coming to have an outpatient surgery, colonoscopy and endoscopy.
[AGENT][NEUTRAL] OK, let me look on that for you.
[AGENT][NEUTRAL] And any dollar amount that I give you will be a verification of benefits and not a guarantee of payment.
[AGENT][NEUTRAL] And you wanted outpatient surgery?
[CUSTOMER][POSITIVE] Yes please.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] I'm showing that the patient has an outpatient benefit maximum of up to $6650 per person per calendar year.
[AGENT][NEUTRAL] With a $500 outpatient deductible per covered person per calendar year.
[AGENT][NEUTRAL] And that does include um surgeries and then outpatient facility. Uh and what else were you needing?
[CUSTOMER][NEUTRAL] So, um, so basically she has a 6650, um, available.
[AGENT][NEUTRAL] Yes, and that's after her primary. So whenever you file a claim, uh, for this insurance, you'll need to send in uh all of the, the necessary claim documents as well as the primary insurance explanation of benefits showing that they paid some.
[CUSTOMER][NEUTRAL] Uh huh.
[CUSTOMER][NEUTRAL] Hm
[AGENT][NEUTRAL] Some or all of the benefits, um, and then we should be able to pick up after that.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][POSITIVE] All right, thank you so much for that. I really appreciate it. And may I please have a reference number for the call?
[AGENT][NEUTRAL] OK, we don't have reference numbers, but you can use my name and last initial in today's date. So it's [PII], in today's date.
[CUSTOMER][POSITIVE] Thank you very much have a good day.
[AGENT][POSITIVE] Great. Thank you for calling APL and have a great day.
[CUSTOMER][NEUTRAL] Bye bye.