AccountId: 011433970860
ContactId: e81c5562-1df6-4c82-bb98-038827128f41
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 241830 ms
Total Talk Time (AGENT): 92749 ms
Total Talk Time (CUSTOMER): 108321 ms
Interruptions: 0
Overall Sentiment: AGENT=1.2, CUSTOMER=1.7
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/04/15/e81c5562-1df6-4c82-bb98-038827128f41_20250415T16:38_UTC.wav
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[AGENT][NEUTRAL] Thank you for calling American Public Life. This is [PII]. How may I assist you?
[CUSTOMER][NEUTRAL] Uh, yes, I was calling to try and figure out benefits for our patient.
[AGENT][NEUTRAL] May I have your name, please?
[CUSTOMER][NEUTRAL] My name is [PII] with Women's Care Florida.
[AGENT][NEUTRAL] And may I please have a callback number?
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] Thank you and may I please have the policy number?
[CUSTOMER][NEUTRAL] Uh, let's see, have a group, is it the outpatient benefits cert number?
[AGENT][NEUTRAL] Yes.
[CUSTOMER][NEUTRAL] On the card, OK, 02501560ML8.
[AGENT][NEUTRAL] And may I have the patient's name and date of birth?
[CUSTOMER][NEUTRAL] [PII], [PII].
[AGENT][NEUTRAL] And thank you so much for verifying the policy M sure you're calling in for benefits. Is this for inpatient, outpatient office setting?
[CUSTOMER][NEUTRAL] Um, she's having outpatient surgery, and we would be billing for the surgeon.
[AGENT][NEUTRAL] And this is done within you said in an outpatient facility?
[CUSTOMER][POSITIVE] Correct.
[AGENT][NEUTRAL] OK, I'm pulling that information up for you now.
[CUSTOMER][POSITIVE] Thank you.
[AGENT][NEUTRAL] You're welcome and verification of coverage does not guarantee the payment of the claim. This policy is currently active with the effective date of [PII] for outpatients, the member has up to $5000 per calendar year that will go towards the primary insurance deductible.
[CUSTOMER][NEUTRAL] Mm
[AGENT][NEUTRAL] Co-insurance or co-pay, this policy is for sickness and injury only. It will not cover any preventative or wellness. Is there anything else that I can assist you with today, [PII]?
[CUSTOMER][NEUTRAL] So when you say um it pays up to $5000 so that's basically covering her deductible?
[AGENT][NEUTRAL] It covers up to the primary insurance deductible, co-insurance, or co-pay up to the $5000.
[CUSTOMER][NEUTRAL] OK, and there's no deductible or co-insurance or anything that applies towards this 5000. It's just a straight $5000 that you pay towards her bills until she meets the $5000 correct?
[AGENT][NEUTRAL] Yes, where there's her supplemental.
[CUSTOMER][NEUTRAL] Uh, OK.
[CUSTOMER][NEUTRAL] OK, uh, so like a gap?
[AGENT][NEUTRAL] Yes.
[CUSTOMER][NEUTRAL] OK, perfect. OK, and do you pay the patient or do you pay directly to the provider?
[AGENT][NEUTRAL] Is who submits the claim in first.
[CUSTOMER][NEUTRAL] OK. OK. Um, and that does covers a surgeon, not just the facility.
[AGENT][NEUTRAL] If the services is rendered for that outpatient, it covers up to that $5000.
[CUSTOMER][NEUTRAL] OK, perfect. I'm just trying to be super, super sure because this patient's a little sticky, so I just want to make sure. OK. And I'm sorry, I didn't catch your name at the beginning.
[AGENT][NEUTRAL] It is [PII].
[AGENT][NEUTRAL] Would you like for me to spell that for you?
[CUSTOMER][NEUTRAL] And is there a uh no, that's OK. Is there a reference number that goes with our call?
[AGENT][NEUTRAL] Yes, the reference number would be first name, last initial of H and today's date.
[CUSTOMER][POSITIVE] Perfect. And are you [PII] with an H or without an H?
[AGENT][NEUTRAL] It's Tarika with a K.
[CUSTOMER][POSITIVE] Oh, I'm sorry, I'm sorry.
[AGENT][POSITIVE] No problem.
[CUSTOMER][POSITIVE] Got it. Thank you so much.
[AGENT][POSITIVE] You're welcome. Thank you for calling American Public Life. Have a great day.
[CUSTOMER][NEUTRAL] You as well bye bye.
[AGENT][POSITIVE] Thank you.