AccountId: 011433970860
ContactId: e8270a31-0e45-4ead-8df7-1dda136a7efe
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 488950 ms
Total Talk Time (AGENT): 182089 ms
Total Talk Time (CUSTOMER): 103570 ms
Interruptions: 0
Overall Sentiment: AGENT=0.5, CUSTOMER=1.2
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/01/22/e8270a31-0e45-4ead-8df7-1dda136a7efe_20250122T18:41_UTC.wav
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[AGENT][NEUTRAL] Thank you for calling APL. This is [PII]. How may I help you?
[CUSTOMER][NEUTRAL] Yes, hello, good afternoon. My name is [PII]. I'm calling from a provider's office trying to get benefits for a patient.
[AGENT][NEUTRAL] OK, Miss [PII], I can help you with benefits for patients. Can you please give me your call back number just in case our call is disconnected.
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] Not a problem. So it is um [PII].
[AGENT][NEUTRAL] OK, thank you and then what is the patient's name?
[CUSTOMER][NEUTRAL] Yes. So the patient's name is Mr. [PII].
[AGENT][NEUTRAL] OK, and then what is the patient's date of birth?
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] His
[CUSTOMER][NEUTRAL] And your date of birth. Um, [PII].
[AGENT][NEUTRAL] Thank you and then do you have his policy number, please?
[CUSTOMER][NEUTRAL] Yes, uh, the policy number.
[CUSTOMER][NEUTRAL] I see payer ID 60801.
[AGENT][NEUTRAL] OK, that's our payer ID to send claims electronically. Do you see an inpatient or an outpatient um.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] Certification number?
[CUSTOMER][NEUTRAL] Oh,
[CUSTOMER][NEUTRAL] Yes, I'm sorry. OK. So it is uh 0237.
[CUSTOMER][NEUTRAL] 2890, M as in Mary, L as in Linda, and 8.
[AGENT][POSITIVE] OK thank you I appreciate that. Let me pull that policy in for us real quick.
[CUSTOMER][POSITIVE] Thank you.
[AGENT][NEUTRAL] OK, so looking at this policy for [PII] on um policy number 2,372,890, I do show that the policy lapsed on [PII] and is no longer active. Let me look though to see if he has anything that is active.
[AGENT][NEUTRAL] He does, he has a different policy number. Let me give that to you.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] It is 256-9532.
[CUSTOMER][NEUTRAL] 32. OK.
[AGENT][POSITIVE] And it is effective, effective um [PII].
[AGENT][NEUTRAL] And this is just to verify his coverage. It's not a guarantee of payment. He has a supplemental insurance policy that is secondary to the primary.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] It helps with deductible, co-pay, and co-insurance, and he has a.
[AGENT][NEUTRAL] Inpatient benefit amount of $6000 per calendar year and then he also has an outpatient benefit amount of $6000 per calendar year.
[CUSTOMER][NEUTRAL] And this is the this is the deductible out of pocket. I'm sorry, the phone cut off a little bit.
[AGENT][POSITIVE] Oh, I'm sorry. It helps with deductible, co-pay, and co-insurance.
[CUSTOMER][NEUTRAL] OK, copay and OK, so this is like the limit of how much, OK.
[CUSTOMER][NEUTRAL] Um,
[CUSTOMER][NEUTRAL] OK, so has he used any of that $6000?
[AGENT][NEUTRAL] Let me check for you.
[CUSTOMER][POSITIVE] Thank you.
[AGENT][POSITIVE] You're welcome.
[AGENT][NEUTRAL] No ma'am, he's not used anything for the year of [PII].
[CUSTOMER][NEUTRAL] OK. Um, does he have a, um, when I checked this last year, does he have a deductible at all?
[CUSTOMER][NEUTRAL] Or out of pocket?
[AGENT][NEUTRAL] Let me check for
[AGENT][NEUTRAL] Yes ma'am, she, he has an outpatient deductible, let's see.
[AGENT][NEUTRAL] For accident or sickness of $1000.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Um, and then the um
[CUSTOMER][NEUTRAL] I checked last year. um, I was told office visit co-pays are not covered. Are they covered now for what under his new plan?
[AGENT][NEUTRAL] Let me check. I'm gonna pull up his policy real quick and see.
[AGENT][NEUTRAL] If he has um office visits.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] On his policy
[CUSTOMER][POSITIVE] Oh, thank you.
[AGENT][NEUTRAL] And this is a physician's office, is that correct?
[CUSTOMER][NEUTRAL] Yes, a specialist office actually, but I don't know if that matters.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] No, let me check real quick though. I'm gonna, it's gonna be a moment while the.
[CUSTOMER][POSITIVE] Sure, not a problem.
[AGENT][NEUTRAL] Policy pulls up and loads for me to be able to look at it, but I do wanna double double check on that.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEGATIVE] Of course it never loads fast when you want it to.
[CUSTOMER][NEUTRAL] OK. That's always happens.
[AGENT][NEUTRAL] Right.
[CUSTOMER][NEUTRAL] That's OK.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] OK, so he has um.
[AGENT][NEUTRAL] Benefits if it's used in an ER urgent care center, MRI imaging center or an ambulatory center. He does not have office visits on his policy.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Um, OK, so that's one thing, um.
[CUSTOMER][NEUTRAL] OK, perfect. Um, may I have a reference number, please?
[AGENT][NEUTRAL] Yes ma'am, you can use my name [PII] in today's date.
[CUSTOMER][POSITIVE] OK, perfect. Um, I'll go ahead and put this in. Thank you so much, ma'am.
[AGENT][POSITIVE] You're very welcome you have a great day and thanks for calling APL.
[CUSTOMER][POSITIVE] Thank you. Have a good day too.
[AGENT][NEUTRAL] Bye bye Miss [PII].
[CUSTOMER][POSITIVE] Have a good day. Bye-bye.