AccountId: 011433970860
ContactId: f2d98003-8fc0-47dd-a63f-d91413a28760
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 308299 ms
Total Talk Time (AGENT): 132668 ms
Total Talk Time (CUSTOMER): 100495 ms
Interruptions: 0
Overall Sentiment: AGENT=0.8, CUSTOMER=0.2
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/01/31/f2d98003-8fc0-47dd-a63f-d91413a28760_20250131T14:16_UTC.wav
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[AGENT][POSITIVE] Good morning. Thank you for calling APL. My name is [PII]. How may I help you?
[CUSTOMER][NEUTRAL] Hi, [PII]. This is [PII] calling from provider's office, and my last name initial is [PII]. I just need to check the eligibility and benefits of a patient. Will you please assist me with that?
[AGENT][POSITIVE] Sure, I'll be more than happy to help you with the eligibility and benefits. And [PII], may I have a good contact number in case we're disconnected?
[CUSTOMER][NEUTRAL] Sure. It is [PII].
[AGENT][NEUTRAL] Thank you for that. And may I have the member's policy number?
[CUSTOMER][NEUTRAL] Yeah, the member policy number is 02483110.
[AGENT][NEUTRAL] And can you verify the member's first and last name and date of birth?
[CUSTOMER][NEUTRAL] Sure. The member's name is [PII] and the date of birth is [PII].
[AGENT][NEUTRAL] Thank you for that and all the information provided is a verification of benefits, not a guarantee of payment. And I am showing the policy is active. It's been effective since [PII].
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] And what type of benefits did you want to go over today?
[CUSTOMER][NEUTRAL] Uh, before that, can I know the plan type?
[AGENT][NEUTRAL] Yes, this is their Medlink supplemental insurance.
[CUSTOMER][NEUTRAL] Uh, uh, plant type supplemental, supplement?
[AGENT][NEUTRAL] Yes, it's a, it's a supplemental insurance policy.
[AGENT][NEUTRAL] The policy name is Medlink.
[CUSTOMER][NEUTRAL] But just a moment.
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] It is a meddling supplement plan, right?
[AGENT][POSITIVE] Yes, that's correct.
[CUSTOMER][NEUTRAL] OK. Is this is a primary policy or secondary policy?
[AGENT][NEUTRAL] This is secondary.
[CUSTOMER][NEUTRAL] OK, the secondary policy. OK. Can I know the benefits details? Can I know the car insurance?
[AGENT][NEUTRAL] Mhm.
[AGENT][NEUTRAL] Can you know the co-insurance? So our policy pays towards the copay, the deductible and co-insurance of covered charges after primary. This policy is broken down into place of service. Are you considered outpatient or inpatient?
[CUSTOMER][NEUTRAL] Outpatient
[AGENT][NEUTRAL] Alright, so for outpatient, the policy would pay.
[AGENT][NEUTRAL] Up to $9100 per person per calendar year.
[CUSTOMER][NEUTRAL] Uh, you mean, uh, now the 9100 is in total deductible?
[AGENT][NEUTRAL] No, no, there's no, so that's the the deductible and out of pocket, that's primary. We help pay those. So um there's a certain amount for the calendar year for inpatient and a certain amount max for outpatient. So for outpatient, the max is $9100.
[CUSTOMER][NEUTRAL] Oh
[CUSTOMER][NEUTRAL] OK. Coinsurances?
[AGENT][NEUTRAL] What, what do you mean co-insurance? It depends on what the
[CUSTOMER][NEUTRAL] Uh, yeah, the patient's responsibility.
[AGENT][NEUTRAL] Whatever is being done.
[AGENT][NEUTRAL] Right, we're the secondary, so we don't have a patient responsibility. Primary does. We help pay the patient responsibility.
[CUSTOMER][NEUTRAL] OK. So,
[CUSTOMER][NEUTRAL] OK. Just for my confirmation, if there is no individual deductible and individual out of pocket, right?
[AGENT][NEUTRAL] Right.
[CUSTOMER][NEUTRAL] OK. Is there is any family detective plan family out of pocket? All right.
[AGENT][NEUTRAL] No, there's no family out of pocket.
[CUSTOMER][NEUTRAL] OK. Can I know the time the filing limit?
[AGENT][NEUTRAL] Um, so there's no, um, filing limit or timely filing limit. As long as the policy is active, you can file the claim at any time.
[CUSTOMER][NEUTRAL] OK. Uh, can I know the claim mailing address?
[AGENT][NEUTRAL] Sure, it's [PII].
[AGENT][NEUTRAL] [PII].
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] [PII].
[CUSTOMER][NEUTRAL] Mm.
[CUSTOMER][NEUTRAL] Mm.
[AGENT][NEUTRAL] [PII].
[AGENT][NEUTRAL] The zip code is [PII].
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Can I get the card reference number?
[AGENT][NEUTRAL] Sure, so there's no call reference number, but you can use my name in today's date. So again, my name is [PII], first initial to my last name is [PII].
[CUSTOMER][POSITIVE] OK. Thank you for your assistance, [PII]. Have a great day. Bye-bye.
[AGENT][POSITIVE] Thank you, [PII], you also, and thanks for calling APL. Bye-bye.