AccountId: 011433970860
ContactId: 01af6f96-9656-4550-8751-fbc37841a7af
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 467109 ms
Total Talk Time (AGENT): 129518 ms
Total Talk Time (CUSTOMER): 89705 ms
Interruptions: 1
Overall Sentiment: AGENT=0, CUSTOMER=-0.3
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/01/15/01af6f96-9656-4550-8751-fbc37841a7af_20250115T22:10_UTC.wav
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[AGENT][NEUTRAL] APL, this is [PII]. How may I assist you?
[CUSTOMER][NEUTRAL] Um, hi, good day. This is [PII] from provider's office. I'm just calling to check for eligibility.
[AGENT][NEUTRAL] I barely hear you. Could you repeat your name again, please?
[CUSTOMER][NEUTRAL] Um it's [PII]
[AGENT][NEUTRAL] Thank you, [PII]. I do apologize for interrupting you, but I could barely hear you when you was providing your name.
[CUSTOMER][NEUTRAL] Mhm
[CUSTOMER][NEUTRAL] Oh OK, sorry.
[CUSTOMER][NEUTRAL] Um, just calling to check for benefits and eligibility.
[AGENT][NEUTRAL] Sure, I can assist you with that, [PII]. Can I have a callback number for you and that policy number?
[CUSTOMER][NEUTRAL] Um, it is [PII] for my callback number. And the policy number is 248.
[CUSTOMER][NEUTRAL] 3111.
[AGENT][NEUTRAL] Could you verify that patient's name and date of birth?
[CUSTOMER][NEUTRAL] Um, this is for, um, it's a yes [PII].
[CUSTOMER][NEUTRAL] Date of birth is [PII].
[AGENT][NEUTRAL] And you're calling to verify eligibility and benefits for what place of service?
[CUSTOMER][NEUTRAL] Um, just for, uh, office, office visit.
[CUSTOMER][NEUTRAL] Office settings.
[AGENT][NEUTRAL] This policy became effective [PII] and is currently active. The member has out this member's policy is a gap insurance that assists with deductible, co-pay and co-insurance and office visits are not covered up.
[CUSTOMER][NEUTRAL] I'm sorry. Can you
[CUSTOMER][NEUTRAL] Can you repeat the eligibility plan date because uh your voice is cutting in and out. Sorry for that.
[AGENT][NEUTRAL] [PII].
[CUSTOMER][POSITIVE] OK, thank you very much.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] The member's policy does not cover office visits?
[CUSTOMER][NEUTRAL] And
[CUSTOMER][NEUTRAL] Oh, OK.
[AGENT][POSITIVE] However, it does cover the treatment received in the office.
[AGENT][NEUTRAL] which falls under the outpatient benefits.
[CUSTOMER][NEUTRAL] I'm sorry, pardon?
[AGENT][NEGATIVE] The office visits are not covered under the policy, and this isn't.
[CUSTOMER][NEUTRAL] Oh, OK.
[AGENT][NEUTRAL] Is there anything else that I can assist you with today?
[CUSTOMER][NEUTRAL] Um, may I know what is the maximum benefit?
[AGENT][NEUTRAL] Could you repeat yourself?
[CUSTOMER][NEUTRAL] I mean, what is the maximum benefit for the patient?
[AGENT][NEUTRAL] The member's policy does not cover office visits.
[CUSTOMER][NEUTRAL] Mhm. Yes, but uh, I have also other procedures.
[AGENT][NEUTRAL] So you, the treatment received in the office covered under the policy?
[CUSTOMER][NEUTRAL] Um, what do you mean? Um, aside from the office visit, I have other procedure for the patient.
[AGENT][NEUTRAL] Which
[AGENT][NEUTRAL] Right, so the policy covers outpatient benefits of not, I'm sorry.
[AGENT][NEUTRAL] Hm.
[AGENT][NEUTRAL] Outpatient benefits.
[AGENT][NEUTRAL] So the outpatient benefits, may I place you on a brief hold because I'm not showing outpatient benefits.
[AGENT][NEUTRAL] So
[CUSTOMER][NEUTRAL] Mhm. Just one benefit in case.
[AGENT][NEGATIVE] I know it's not good.
[CUSTOMER][NEGATIVE] You are on hold.
[CUSTOMER][NEGATIVE] You are on hold.
[CUSTOMER][NEGATIVE] You are on hold.
[AGENT][NEUTRAL] Thank you for holding Clover. So the member's policy has $9100 per calendar year for inpatient and outpatient benefits combined. So the treatment received in the office will fall under the benefit of the inpatient outpatient benefit amount of $9100 and this is not a guaranteed benefits, just a disclaimer of the policy's coverage.
[CUSTOMER][NEUTRAL] I'm sorry, it's 1900.
[AGENT][NEUTRAL] 910 9100, 9100.
[CUSTOMER][POSITIVE] Oh, OK. Thank you for that. And sorry, uh, so we'll be
[CUSTOMER][NEUTRAL] Will the office visit be covered now?
[AGENT][NEUTRAL] No, office visits are not covered. Uh office visit is not considered as inpatient or outpatient. Only the treatment received in the office falls under the outpatient benefits. Office visits are not covered under the policy.
[CUSTOMER][POSITIVE] Oh, OK, no problem.
[CUSTOMER][NEUTRAL] Mhm. OK. Thank you very much for that. And may I just have a reference number for [PII] and your name?
[AGENT][NEUTRAL] We don't provide those unfortunately, [PII], but you can use my name and today's date as a reference. It's [PII].
[CUSTOMER][POSITIVE] OK, thank you very much. You have a great day. Thank you. Bye.
[AGENT][POSITIVE] Thanks for calling APL and have a great day.