AccountId: 011433970860
ContactId: e7fff8cc-9c05-4308-8e6c-ede6d6afa309
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 265179 ms
Total Talk Time (AGENT): 116655 ms
Total Talk Time (CUSTOMER): 100089 ms
Interruptions: 1
Overall Sentiment: AGENT=0.5, CUSTOMER=0.7
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/01/13/e7fff8cc-9c05-4308-8e6c-ede6d6afa309_20250113T21:33_UTC.wav
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[AGENT][NEUTRAL] Thank you for calling APL. This is [PII]. How may I help you?
[CUSTOMER][NEUTRAL] Hey, I was calling to um find out if a patient has an active medical plan and if it's a supplemental plan.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] And what's the policy number?
[CUSTOMER][NEUTRAL] It looks like it's 02506174.
[AGENT][NEUTRAL] And what's a good phone number in case we're disconnected?
[CUSTOMER][NEUTRAL] My line is a direct line [PII].
[AGENT][NEUTRAL] And what's your name?
[CUSTOMER][NEUTRAL] My name is [PII].
[AGENT][NEUTRAL] OK, thank you, [PII]. And you're wanting, um, eligibility and benefit information?
[CUSTOMER][NEUTRAL] Yes, please.
[AGENT][NEUTRAL] OK. And you said it's outpatient, uh, hospital facility?
[CUSTOMER][POSITIVE] Yes, correct.
[AGENT][NEUTRAL] Or in, OK, all right, give me one moment.
[CUSTOMER][NEUTRAL] Just outpatient mhm.
[AGENT][NEUTRAL] Mhm. In a hospital?
[CUSTOMER][NEUTRAL] Yes.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] And what is the patient's name and date of birth?
[CUSTOMER][NEUTRAL] [PII], [PII].
[AGENT][NEUTRAL] Mhm.
[AGENT][NEUTRAL] Thank you. So I'm showing an effective date of [PII]. The policy is active at this time.
[AGENT][NEUTRAL] And the maximum outpatient benefit.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] Is up to $3000 per covered person.
[AGENT][NEUTRAL] Uh, that is per calendar year and then there's a, um, all combined maximum for uh covered persons up to $9000 per year per calendar year.
[AGENT][NEUTRAL] And currently,
[AGENT][NEUTRAL] I'm not showing any of the benefit used for [PII] and of course the information provided is verification, not a guarantee of payment.
[CUSTOMER][NEUTRAL] Is that the out of pocket max?
[AGENT][NEUTRAL] That's the, the benefit under this policy, so it's.
[CUSTOMER][NEUTRAL] OK, so it has like a $1 max instead of visits, correct?
[AGENT][NEUTRAL] Correct. What type of service is it when you say visits?
[CUSTOMER][NEUTRAL] Um, physical therapy.
[AGENT][NEUTRAL] OK, so it's $1 maximum.
[CUSTOMER][NEUTRAL] OK, so just $1 maximum, not the.
[AGENT][NEUTRAL] The number of visits.
[CUSTOMER][NEUTRAL] Um, visit limits, so the 3, the 3000 is for um.
[AGENT][POSITIVE] Correct.
[CUSTOMER][NEUTRAL] Individual and a 9000 for family, is that correct?
[AGENT][POSITIVE] Correct.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] And would the patient have any responsibility?
[AGENT][NEUTRAL] OK, so we can't determine that until we get the primary's explanation of benefits since this policy is secondary to the major medical.
[CUSTOMER][NEUTRAL] OK, so we'll
[CUSTOMER][NEUTRAL] OK, we'll be secondary. Would we have to have any type of authorization in place?
[AGENT][NEUTRAL] Authorization isn't required.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] So this files after and physical therapy would be a covered benefit under this plan?
[AGENT][NEUTRAL] Under the outpatient benefit quoted, that is correct.
[CUSTOMER][POSITIVE] OK, great.
[CUSTOMER][NEUTRAL] I think I have um.
[AGENT][NEUTRAL] Any other
[CUSTOMER][NEUTRAL] I think I have everything that I need. You wouldn't really know what the patient's responsibility would be until you receive the ELB from the primary.
[AGENT][NEUTRAL] Correct, because it depends on, yeah, what they apply towards deductible, co-insurance and or co-pay of coverage charges.
[CUSTOMER][NEUTRAL] After they paid. OK.
[CUSTOMER][NEUTRAL] OK great um now would there be a reference number for our call?
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] And we do not determine patients responsibility. Um, you'll use my name in today's date as your reference. It's [PII].
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] ONYA.
[CUSTOMER][NEUTRAL] Uh-huh.
[AGENT][NEUTRAL] And first initial of last name is [PII]
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] As in [PII]. And any other questions, Ms. [PII]?
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][POSITIVE] I think that's it, Ms. [PII]. Thank you so much for covering that for me.
[AGENT][POSITIVE] Uh, you're welcome and thank you for calling APL. Have a good day.
[CUSTOMER][POSITIVE] OK you too bye.
[AGENT][NEUTRAL] Um, bye-bye.