AccountId: 011433970860
ContactId: e88df208-ed03-421b-a781-5e6c481694e2
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 413440 ms
Total Talk Time (AGENT): 163333 ms
Total Talk Time (CUSTOMER): 97478 ms
Interruptions: 1
Overall Sentiment: AGENT=0.4, CUSTOMER=0.9
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/06/18/e88df208-ed03-421b-a781-5e6c481694e2_20250618T16:02_UTC.wav
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[AGENT][NEUTRAL] Thank you for calling APL. This is [PII]. How can I help you?
[CUSTOMER][NEUTRAL] Hey, [PII], this is [PII] calling from Baptist Memorial Hospital. How are you?
[AGENT][NEUTRAL] Good and you?
[CUSTOMER][POSITIVE] Doing good. I've got a patient coming into our facility today for surgery, and I'm calling to verify the benefits on this.
[AGENT][POSITIVE] OK, I can help you with benefits. Um, can I get a good callback number in case we get disconnected?
[CUSTOMER][NEUTRAL] Yes, it is [PII], no extension.
[AGENT][POSITIVE] Thank you so much. And do you have the policy number?
[CUSTOMER][NEUTRAL] I do. It is 02616652.
[AGENT][NEUTRAL] OK give me just a moment while I look that up.
[AGENT][NEUTRAL] Can you verify the patient's name and date of birth for me please?
[CUSTOMER][NEUTRAL] [PII] [PII].
[AGENT][NEUTRAL] It looks like this policy is active.
[AGENT][NEUTRAL] Let me go ahead and pull up his policy and see what all benefits he has.
[CUSTOMER][NEUTRAL] OK, and can I get the effective date?
[AGENT][NEUTRAL] Yes, ma'am. The effective date is [PII].
[AGENT][NEUTRAL] And this is his secondary gap insurance, so it does help with co-pay, co-insurance, and co-deductible. Is there anything in particular you're looking at like uh in hospital or outpatient benefits?
[CUSTOMER][NEUTRAL] Um, outpatient surgery.
[AGENT][NEUTRAL] Oh, OK, and this is just a verification of benefits, not a guarantee of payment. They have a maximum outpatient benefit of up to $3000 per calendar year per covered person.
[AGENT][NEUTRAL] Looks like the outpatient deductible is $1000 per calendar year. It's waived if there uh for an accident.
[AGENT][NEUTRAL] And you're wanting surgery. Let's see.
[CUSTOMER][NEUTRAL] Mhm
[AGENT][NEUTRAL] Looks like outpatient surgery in a hospital.
[CUSTOMER][NEUTRAL] So this is a gap insurance, it's not, uh-huh.
[AGENT][NEUTRAL] Right, it's not there, we're not major medicals, uh.
[CUSTOMER][NEUTRAL] No, go ahead, I'm sorry.
[AGENT][NEUTRAL] It will help with their primary insurance carrier. Um, but it does allow for outpatient surgery in a hospital outpatient facility or free-standing outpatient surgery center.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] And you said it's $1000 deductible?
[AGENT][NEUTRAL] Yes ma'am, it's waived if there's an accident.
[CUSTOMER][NEUTRAL] And
[CUSTOMER][NEUTRAL] Have they met any of that deductible?
[AGENT][NEUTRAL] Let me look.
[AGENT][NEUTRAL] It looks like they have not used their benefits uh to date.
[CUSTOMER][NEUTRAL] OK, so 0 may have that 0 benefits to you.
[CUSTOMER][NEUTRAL] Now what is it paid? Is it a co-insurance after the deductible?
[AGENT][NEUTRAL] It will help pick up uh the leftover deductible or co-insurance or co-pay from the primary.
[CUSTOMER][NEUTRAL] OK, so.
[CUSTOMER][NEUTRAL] 100 $1000 deductible, zero me then covers up 100% up to the max of $3000 per calendar year.
[AGENT][NEUTRAL] Uh, the
[CUSTOMER][NEGATIVE] And no benefits have been used.
[AGENT][NEUTRAL] The maximum in hospital is 6000.
[CUSTOMER][NEUTRAL] Out of hospital 6000.
[CUSTOMER][NEUTRAL] And the group number?
[AGENT][NEUTRAL] Let me look.
[AGENT][NEUTRAL] The group number is 15027.
[CUSTOMER][NEUTRAL] And did the patient have a payer, can I get the payer ID and the claims address?
[AGENT][NEUTRAL] Yes ma'am. Our payer ID is 60801.
[AGENT][NEUTRAL] And if you want the fax number or the mailing address?
[CUSTOMER][NEUTRAL] Uh both please.
[AGENT][NEUTRAL] Our fax number is [PII].
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] And the um mailing address, OK.
[CUSTOMER][NEUTRAL] I'm ready for the claims address whenever you are.
[AGENT][NEUTRAL] It's [PII].
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] [PII]
[CUSTOMER][NEUTRAL] You know is prices are gonna be required?
[AGENT][NEGATIVE] Um, not for us.
[CUSTOMER][NEUTRAL] No place are required, OK, and this isn't a limited benefit plan. It's a gap insurance, correct?
[AGENT][NEUTRAL] Right, this is just secondary gap insurance. Um, I can tell you who their primary insurance carrier is, but I don't know their, their member ID or anything like that.
[CUSTOMER][POSITIVE] Uh no, that's OK. Well, thank you so much for your help. Can I get a reference number for our call or just use your name?
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] So you'll use my name last initial, and today's date. So [PII], and today's date.
[CUSTOMER][POSITIVE] Thank you so much. You have a wonderful day.
[AGENT][POSITIVE] You too and thank you for calling APL.
[CUSTOMER][POSITIVE] Thank you, bye bye.
[AGENT][NEUTRAL] Bye.