AccountId: 011433970860
ContactId: 001c1e77-6fef-4e07-9d81-57033c0fbb5a
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 281220 ms
Total Talk Time (AGENT): 107697 ms
Total Talk Time (CUSTOMER): 58605 ms
Interruptions: 0
Overall Sentiment: AGENT=0.6, CUSTOMER=0.2
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/01/29/001c1e77-6fef-4e07-9d81-57033c0fbb5a_20250129T19:16_UTC.wav
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[AGENT][NEUTRAL] Thank you for calling American Public Life. This is [PII]. How may I assist you?
[CUSTOMER][NEUTRAL] Uh yes ma'am, I'm trying to verify a patient's benefits.
[AGENT][NEUTRAL] May I have your name and a callback number?
[CUSTOMER][NEUTRAL] [PII] at [PII].
[AGENT][NEUTRAL] And [PII], may I please have the policy number?
[CUSTOMER][NEUTRAL] It is 02566774.
[AGENT][POSITIVE] Thank you.
[AGENT][NEUTRAL] May I have the patient's name and date of birth?
[CUSTOMER][NEUTRAL] [PII] date of birth [PII].
[AGENT][NEUTRAL] And are you calling in for medical benefits?
[CUSTOMER][NEUTRAL] Yes ma'am.
[CUSTOMER][NEUTRAL] Is this not is this not a medical plan?
[AGENT][NEUTRAL] So for the medical, the correct policy number is 02.
[AGENT][NEUTRAL] 56.
[AGENT][NEUTRAL] 687 2.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Are you still able to give me benefits?
[AGENT][NEUTRAL] Yes, I'm pulling the information up now.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] And what specific benefits are you needing for me to verify?
[CUSTOMER][NEUTRAL] Uh, for a specialist office visit.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] I apologize my system is running kind of slow.
[CUSTOMER][NEUTRAL] That's OK.
[AGENT][NEUTRAL] And it looks like for this member verification of coverage does not guarantee the payment of the claim. The member does have up to $75 per visit with a maximum of 6 visits per calendar year.
[CUSTOMER][NEUTRAL] Alright, and how many visits have been used?
[AGENT][NEGATIVE] As of right now, the member has not used any of their benefits.
[CUSTOMER][NEUTRAL] And are there any exclusions?
[AGENT][NEUTRAL] With this policy, it is an indemnity policy which is a limited benefit so that amount is the maximum amount that will be paid out if there's anything that is left over, then that is considered as patients responsibility and just in case I didn't give the disclaimer verification of coverage does not guarantee the payment of the claim. Is there anything else that I can assist you with today, [PII]?
[CUSTOMER][NEUTRAL] Is a referral required?
[AGENT][NEUTRAL] No referral is required.
[CUSTOMER][NEUTRAL] And what about if he got any procedures?
[AGENT][NEUTRAL] That amount is the maximum amount for the office setting.
[CUSTOMER][NEUTRAL] OK, so just up to the $75?
[AGENT][NEUTRAL] Yes.
[CUSTOMER][NEUTRAL] Alright, and what fee schedule do y'all go off of what network?
[AGENT][NEUTRAL] This is an indemnity which is a limited benefit so it's not a network and you can check with multi plan to see if that is working for their network.
[CUSTOMER][NEUTRAL] OK, multi plan PHCS, OK.
[AGENT][NEUTRAL] Yes.
[AGENT][NEUTRAL] Multiplayer network, yes.
[CUSTOMER][NEUTRAL] All right, can I get a reference number?
[AGENT][NEUTRAL] The reference will be my first name [PII], which is spelled [PII] last initial of [PII] and today's date.
[CUSTOMER][NEUTRAL] Uh, one more question, would if he got any procedures, with a prior authorization be required?
[AGENT][NEUTRAL] For this policy, no prior art is required.
[CUSTOMER][POSITIVE] OK, all right, thank you that's all I needed.
[AGENT][POSITIVE] You're welcome thank you for calling American Public Life. Have a great day.
[CUSTOMER][NEUTRAL] You too bye.
[AGENT][POSITIVE] Thank you. Bye bye.