AccountId: 011433970860
ContactId: f23e5292-ac5d-4ba8-b552-69dd711c98b2
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 312480 ms
Total Talk Time (AGENT): 117470 ms
Total Talk Time (CUSTOMER): 116746 ms
Interruptions: 0
Overall Sentiment: AGENT=0.6, CUSTOMER=0.1
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/05/20/f23e5292-ac5d-4ba8-b552-69dd711c98b2_20250520T16:54_UTC.wav
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[CUSTOMER][NEUTRAL] Yeah, your doctors talking.
[AGENT][NEUTRAL] Thank you for calling APL. This is [PII]. How can I help you?
[CUSTOMER][NEUTRAL] Hi there, I'm calling from Baptist Westchester Diagnostic Center. Um, I'm calling to see the benefits of a patient.
[AGENT][POSITIVE] Sure, I can help you with benefits. Can I get your name?
[CUSTOMER][NEUTRAL] Yeah
[CUSTOMER][NEUTRAL] My name is [PII].
[AGENT][NEUTRAL] OK [PII], and can I get a good call back number in case we get disconnected?
[CUSTOMER][NEUTRAL] Yes, it's [PII].
[AGENT][NEUTRAL] What's the policy number?
[CUSTOMER][NEUTRAL] Uh, uh, let me see, hold on, sorry.
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Mm.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Sorry, it's because the patient went into the exam, but I have it here.
[AGENT][NEUTRAL] Yeah, OK.
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] I'm just pulling it up, OK, um.
[CUSTOMER][NEUTRAL] The group number is what you need?
[AGENT][NEUTRAL] Is there anything that says policy certification number?
[CUSTOMER][NEUTRAL] Uh,
[CUSTOMER][NEUTRAL] Let me see.
[AGENT][NEUTRAL] Or I can look her up by her social too, um, if that, if that works.
[CUSTOMER][NEUTRAL] Let me see, cause I'm looking at the card. This is American Public Life, right?
[AGENT][NEUTRAL] Yes ma'am, there there should be something on it that says policy cert policy certification number because the group number is unique to the employer.
[CUSTOMER][NEUTRAL] Oh, OK.
[CUSTOMER][NEUTRAL] Mm, cause what I see here is in hospital benefit cert number and then outpatient benefit cert number.
[AGENT][NEUTRAL] Either one of those will work.
[CUSTOMER][NEUTRAL] It doesn't say
[CUSTOMER][NEUTRAL] Oh, OK. So 02.
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] 54
[CUSTOMER][NEUTRAL] 9409 ML 8.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] All right, let me pull that up for you real quick.
[CUSTOMER][NEUTRAL] Yeah
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] And can I get you to verify the patient's name and date of birth?
[CUSTOMER][NEUTRAL] Yes, date of birth is [PII]. The name is [PII].
[CUSTOMER][NEUTRAL] [PII].
[AGENT][POSITIVE] OK, thank you so much.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] I'm showing that this policy is active with an effective date of [PII].
[AGENT][NEUTRAL] This is a Medlink policy, so it's secondary gap insurance, so it'll go towards co-pay, co-insurance, and co-deductible. Um, and to file a claim for this, you will need the major medicals ELB um to show that that part has been paid first because if major medical denies it, it will deny this one as well. Um, and what were you looking for specific benefits?
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Um, cause, let me see, I think what she owed was like $400 what her other insurance like couldn't cover.
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Um, let me see, let me pull her up.
[CUSTOMER][NEUTRAL] Mm.
[CUSTOMER][NEUTRAL] Yeah, so it says the patient responsibility is 482. I just wanted to make sure that um that she has more than that available as like a benefit to cover her co-pay.
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] I
[CUSTOMER][NEUTRAL] Oh.
[AGENT][NEUTRAL] For a co-pay? Is it in hospitals, out outpatient?
[CUSTOMER][NEUTRAL] Outpatient, yeah, it's a diagnostic center.
[AGENT][NEUTRAL] OK.
[AGENT][POSITIVE] OK. I'm so sorry you said that.
[CUSTOMER][NEUTRAL] It's OK.
[AGENT][NEUTRAL] Give me one moment. Now this is a verification of benefits and not necessarily a guarantee of payment. It looks like she has with this policy, an outpatient benefit maximum of up to $4000 per covered person per calendar year.
[CUSTOMER][NEUTRAL] It's OK.
[CUSTOMER][NEUTRAL] Oh
[CUSTOMER][NEUTRAL] Right.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] Um, let me see.
[CUSTOMER][NEUTRAL] Alright, so then she's all set.
[AGENT][NEUTRAL] Right. And let me make sure. It should be fine, but I just wanna double check something real quick.
[CUSTOMER][NEUTRAL] I
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] OK, yes, and diagnostic testing in a hospital um is covered.
[AGENT][NEUTRAL] For that.
[AGENT][NEUTRAL] And is there any other questions?
[CUSTOMER][NEUTRAL] Nope, that's it.
[AGENT][POSITIVE] Alright, well thank you so much for calling AP [PII]. I hope you have a great day.
[CUSTOMER][POSITIVE] Thank you so much for your help.
[CUSTOMER][NEUTRAL] OK likewise bye bye.
[AGENT][NEUTRAL] Bye bye.