AccountId: 011433970860
ContactId: e6da61ba-6af8-43b3-b26b-1273bea3d859
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 207699 ms
Total Talk Time (AGENT): 120642 ms
Total Talk Time (CUSTOMER): 56457 ms
Interruptions: 1
Overall Sentiment: AGENT=0.6, CUSTOMER=0.7
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/02/05/e6da61ba-6af8-43b3-b26b-1273bea3d859_20250205T20:40_UTC.wav
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[AGENT][NEUTRAL] Good afternoon. Thank you for calling APL. This is [PII]. How may I help you today?
[CUSTOMER][NEUTRAL] Hi, good afternoon. I'm calling from a facility and I need to check gap benefits for a patient that's here and has a responsibility with her main insurance.
[AGENT][POSITIVE] OK, I'll be glad to help you go and give me your name and the member's policy number please.
[CUSTOMER][NEUTRAL] It's [PII], and I have a payer ID and a group ID.
[AGENT][NEUTRAL] No, I need the certificate number. [PII] should be on their ID card. Do you see that anywhere? It can be certificate number.
[CUSTOMER][NEUTRAL] Uh, I have.
[CUSTOMER][NEUTRAL] Oh, I see it, yes. Uh, for outpatient benefit, it's 02415265 MLB.
[AGENT][NEUTRAL] Yeah.
[AGENT][POSITIVE] Alrighty. All good. Thank you so much for that information. Now while I'm pulling this up, go ahead and give me a good return telephone call number, please.
[CUSTOMER][NEUTRAL] [PII]
[AGENT][NEUTRAL] All right, all good. Thank you for that information and hold on just a moment. My computer is slow today, so bear with me just a moment, OK?
[CUSTOMER][POSITIVE] Thank you.
[AGENT][NEUTRAL] Yes, ma'am.
[CUSTOMER][NEGATIVE] You are on hold.
[AGENT][NEGATIVE] You got to go. I'm on this phone and you can't be doing all this thing now.
[AGENT][NEUTRAL] Yeah.
[AGENT][NEUTRAL] Uh
[AGENT][NEUTRAL] Alrighty, thank you for holding. Looks like it's coming up now. OK, what's your patient's name and date of birth today?
[CUSTOMER][NEUTRAL] [PII] [PII].
[AGENT][NEUTRAL] All right, looks like [PII], is it dependent on this medical supplemental plan, does show the original effective date.
[AGENT][NEUTRAL] As of [PII], patient is current and active, but I must advise that verification of coverage is not a guarantee of benefit, but you did say you want outpatient benefit, is that correct, Olga?
[CUSTOMER][NEUTRAL] Ah, yes, because we're not a hospital, we're a facility.
[AGENT][NEUTRAL] Alrighty, let me get that benefit pad pulled up now. I go, what we are is, of course, her medical supplemental plan. So the only thing we will pick up and pay on is for sickness and injury. Nothing routine here is covered no matter what, and it has to apply towards patients deductible, co-pay, or co-insurance at her primary insurance carrier in order for us to review it for payment here. Now her outpatient.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] Benefit here is going to be a zero deductible, no pre-cert, and she has a $400 benefit payable per calendar day.
[CUSTOMER][POSITIVE] Perfect. OK. And do you get reference numbers?
[AGENT][NEUTRAL] No, we don't give reference numbers, but you can use my name in today's date if you need to do so. And my name is [PII], and is that all that I can help answer for you today?
[CUSTOMER][NEUTRAL] That's all. Can you spell your name, please?
[AGENT][NEUTRAL] I sure will [PII]. It's [PII].
[CUSTOMER][POSITIVE] Thank you, I appreciate that. Have a good day.
[AGENT][POSITIVE] Yeah, you as well, [PII], and thanks for calling APL. Bye-bye.
[CUSTOMER][NEUTRAL] Bye bye.