AccountId: 011433970860
ContactId: fdeb0c6b-cdae-4c83-8250-5fe2cafe2905
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 220460 ms
Total Talk Time (AGENT): 83132 ms
Total Talk Time (CUSTOMER): 72181 ms
Interruptions: 0
Overall Sentiment: AGENT=1.7, CUSTOMER=1.3
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/06/11/fdeb0c6b-cdae-4c83-8250-5fe2cafe2905_20250611T19:36_UTC.wav
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[AGENT][POSITIVE] Good good afternoon. Thank you for calling APL. My name is [PII]. How may I help you?
[CUSTOMER][NEUTRAL] Hi, [PII]. My name is [PII]. I'm calling from Holy Cross Hospital, uh, calling in reference of a patient trying to get their general benefits for our patient imaging. Um, I understand that this is a secondary for this patient, but just to get the details as my system didn't pick up your plan.
[AGENT][POSITIVE] OK, well I'll be more than happy to help you with the benefits and can you repeat your name for me please?
[CUSTOMER][POSITIVE] Absolutely. That's [PII]
[AGENT][NEUTRAL] And may I have a good contact number in case we're disconnected and the policy number?
[CUSTOMER][NEUTRAL] Sure thing. It's uh [PII]. That's a direct line. For the patient, I have uh
[CUSTOMER][NEUTRAL] [PII] M as in Mary, [PII] Lima number 8.
[CUSTOMER][NEUTRAL] Oh wait, that's a certification number, huh.
[AGENT][NEUTRAL] No, that's the correct number.
[CUSTOMER][NEUTRAL] So what would be the, that is? Oh, OK, OK, OK, OK.
[AGENT][NEUTRAL] Yes. And can you verify the member's first and last name and date of birth?
[CUSTOMER][NEUTRAL] I have first name [PII], last name [PII]. Date of birth [PII].
[AGENT][NEUTRAL] Thank you for that and all the information provided is a verification of benefits, not a guarantee of payment. Um, so I am showing the policy is active, it's been effective since [PII].
[AGENT][NEUTRAL] So for the outpatient um imaging, hold on one moment, I'm waiting for the benefits to populate here.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] The policy will pay up to $8000 per calendar year towards outpatient expenses. That does include diagnostic testing in a hospital outpatient facility or an MRI facility. They also have the office treatment riders, so if the imaging is done in office, it could be covered up to that $8000 per calendar year.
[AGENT][NEUTRAL] Did you want me to see if any has been used?
[CUSTOMER][NEUTRAL] Um, yes, please.
[AGENT][NEUTRAL] OK, hold on one moment.
[AGENT][NEUTRAL] So it's 8000.
[AGENT][NEUTRAL] So what has he used? Hold on one second.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] So he's used $103.88. He has $7,896.12 left for the year.
[CUSTOMER][NEUTRAL] All righty. Perfect. So this, uh, if I understand this plan wouldn't have a deductible out of pocket coinsurance or co-payment. It's just a flat.
[CUSTOMER][NEUTRAL] Uh, amount, right?
[AGENT][NEUTRAL] Right, we pay towards the copay, deductible and co-insurance applied by primary.
[CUSTOMER][POSITIVE] Got you, got you, got you. Alrighty. Makes sense. That answers my question. Perfect. Thank you so much. I really appreciate your help today.
[AGENT][POSITIVE] You're very welcome. Was there anything else I can assist you with today?
[CUSTOMER][POSITIVE] No, that'll be all. Thank you so much.
[AGENT][POSITIVE] All right, you're welcome. Thanks for calling [PII]. I hope you have a great day.
[CUSTOMER][NEUTRAL] Bye-bye.