AccountId: 011433970860
ContactId: ed1033df-f166-47f0-8858-5a8fb16b4571
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 221600 ms
Total Talk Time (AGENT): 93157 ms
Total Talk Time (CUSTOMER): 85569 ms
Interruptions: 0
Overall Sentiment: AGENT=0.9, CUSTOMER=0.5
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/01/02/ed1033df-f166-47f0-8858-5a8fb16b4571_20250102T18:49_UTC.wav
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[AGENT][NEUTRAL] Thank you for calling APL. This is [PII]. How may I help you?
[CUSTOMER][POSITIVE] Hi, I'm calling from Progressive therapy to get basic eligibility and benefits for a member.
[AGENT][POSITIVE] OK, I can help you with eligibility and benefits. Can I please get your name and your callback number?
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][POSITIVE] Good.
[CUSTOMER][NEUTRAL] Yes, my name is [PII] [PII].
[CUSTOMER][NEUTRAL] If you are a broker, that's fine.
[AGENT][NEUTRAL] OK, Miss [PII], what is the, um, patient's name?
[CUSTOMER][NEUTRAL] [PII].
[CUSTOMER][NEUTRAL] Get started
[AGENT][NEUTRAL] OK, and then what's [PII]'s date of birth?
[CUSTOMER][NEUTRAL] to the members.
[CUSTOMER][NEUTRAL] Located on the front of the Oscar ID card.
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] And the patient's policy number?
[CUSTOMER][NEUTRAL] Um, 01812661 ML 8.
[AGENT][POSITIVE] OK, thank you so much. Let me pull the policy in.
[CUSTOMER][NEUTRAL] Mm
[AGENT][NEUTRAL] OK, I do show that [PII] does have an active policy. Her effective date is [PII].
[CUSTOMER][NEUTRAL] Yeah
[AGENT][NEUTRAL] And this is just to verify benefits, it's not a guarantee of payment.
[CUSTOMER][NEUTRAL] Just
[AGENT][NEUTRAL] This is a supplemental insurance policy that's billed secondary to the primary. It helps with deductible, co-pay, and co-insurance.
[CUSTOMER][NEUTRAL] It
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] She has an inpatient benefit amount of $4000 per calendar year and an outpatient benefit amount of $1000 per calendar year.
[CUSTOMER][NEUTRAL] Patient
[CUSTOMER][NEUTRAL] OK
[CUSTOMER][NEUTRAL] Have any of those $1000 been used?
[AGENT][NEUTRAL] Uh, let me look.
[AGENT][NEGATIVE] Nothing has been used for the year of [PII].
[CUSTOMER][NEUTRAL] Perfect. So those $1000 go into the copay, right? So you guys cover the copay until those $1000 are exhausted?
[AGENT][NEUTRAL] Right, we help with deductible, co-pay, and coinsurance up to $1000 for outpatient.
[CUSTOMER][NEUTRAL] I
[CUSTOMER][NEUTRAL] Do you guys follow Medicare guidelines?
[AGENT][NEUTRAL] No, ma'am.
[CUSTOMER][NEUTRAL] You don't?
[AGENT][NEUTRAL] No.
[AGENT][NEUTRAL] It's not a major medical insurance, so there isn't a guideline.
[CUSTOMER][NEUTRAL] Sorry, can you repeat that?
[AGENT][NEUTRAL] It's not a major medical insurance, so it's there's not a guideline.
[CUSTOMER][NEUTRAL] OK, so, but you, OK, but you guys do cover the, the.
[CUSTOMER][NEUTRAL] The copay.
[AGENT][NEUTRAL] Yeah, the deductible, co-pay or co-insurance.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Is authorization required or anything?
[AGENT][NEUTRAL] No, ma'am.
[CUSTOMER][POSITIVE] OK perfect thank you so much.
[AGENT][POSITIVE] You're very welcome, Miss [PII]. Is there anything else I can help you with before we go?
[CUSTOMER][NEGATIVE] No thank you.
[AGENT][POSITIVE] Alright, well you have a great day and thanks for calling APL.
[CUSTOMER][POSITIVE] Thank you bye bye.
[AGENT][NEUTRAL] Mm, bye-bye.