AccountId: 011433970860
ContactId: 02573ac5-6fa3-4982-8916-d2b361a2e523
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 348089 ms
Total Talk Time (AGENT): 89998 ms
Total Talk Time (CUSTOMER): 135568 ms
Interruptions: 1
Overall Sentiment: AGENT=0.7, CUSTOMER=0.4
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/03/05/02573ac5-6fa3-4982-8916-d2b361a2e523_20250305T15:09_UTC.wav
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[AGENT][POSITIVE] Good morning. Thank you for calling APL. This is [PII]. May I help you?
[CUSTOMER][NEUTRAL] Good morning. I'm calling from a PCP office. I'm trying to verify benefits and eligibility for one of my patients.
[AGENT][NEUTRAL] OK, I can verify benefits for you and your name is?
[CUSTOMER][NEUTRAL] My name is [PII].
[AGENT][NEUTRAL] OK, and Ms. [PII], what is that policy number, please?
[CUSTOMER][NEUTRAL] Let me get that. Give me 1 2nd.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] No, I youakaha in, in there there's a, yeah, yeah, in the lab I threw them away because the box was empty.
[AGENT][NEUTRAL] Are you still looking for the policy number?
[CUSTOMER][NEUTRAL] Yes, I'm sorry, one second.
[AGENT][NEUTRAL] No, you're fine.
[CUSTOMER][NEUTRAL] What do you say what you say.
[CUSTOMER][NEUTRAL] It's
[CUSTOMER][NEUTRAL] 0167.
[CUSTOMER][NEUTRAL] 3603 M as in Mary, L as in Larry, 8.
[AGENT][POSITIVE] OK, thank you so much. And do you have a callback number, Ms. [PII], in case the call drops?
[CUSTOMER][NEUTRAL] Yes, [PII].
[CUSTOMER][NEUTRAL] [PII].
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] OK, thank you. And the patient's name, date of birth?
[CUSTOMER][NEUTRAL] Uh, [PII] [PII].
[AGENT][NEUTRAL] OK, uh, trying to, I'm sorry, his effective date is [PII]. Policy is active, and what benefits you're needing for the patient?
[CUSTOMER][NEUTRAL] I'm, I'm calling to see if we're in network with the patient's plan and if we are, um, he has this insurance as his secondary so I'm trying to see if.
[CUSTOMER][NEUTRAL] Because he has Aetna as his primary, he has a $10 co-pay, so I just wanna know if you guys would cover that co-pay and then he'd be covered in full.
[AGENT][NEUTRAL] OK. Well,
[CUSTOMER][NEUTRAL] For the office visit.
[AGENT][NEUTRAL] OK. Is it for a specialist or general office visit?
[CUSTOMER][NEUTRAL] Uh, we're a, well, it's a, we're a primary care doctor's office, so I, I guess it'd be a PCP office visit.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] OK. Well, um, with the policy is secondary, we don't have a network.
[AGENT][NEUTRAL] But an office visits are covered under the policy, um, not a guarantee of payment, just a verification of coverage. For an office visit, the max we pay is up to $25 per visit. They have a total of 4 visits per year.
[CUSTOMER][NEUTRAL] OK. So, the secondary insurance.
[CUSTOMER][NEUTRAL] If the primary has a $10 co-pay, then you guys would cover that only for 4 visits.
[AGENT][NEUTRAL] That's what we pick up, up to 4 visits per year. Yes, ma'am.
[CUSTOMER][NEUTRAL] OK, so secondary.
[CUSTOMER][NEUTRAL] Insurance covers.
[CUSTOMER][NEUTRAL] Copies up to.
[CUSTOMER][NEUTRAL] $25.
[CUSTOMER][NEUTRAL] Only 24 visits per year.
[CUSTOMER][NEUTRAL] So the patient will be covered in full for only 4 visits?
[AGENT][NEUTRAL] Uh, we pay up to 25, up to 4. Yes, ma'am.
[CUSTOMER][NEUTRAL] Basically, per year.
[CUSTOMER][NEUTRAL] And then after he'd have to go back to paying the $10 copay that his primary requires him to pay.
[AGENT][NEUTRAL] Uh, that would be once the benefits of max, then it would be on the patient.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK, and are we in network with the plan?
[AGENT][NEUTRAL] Uh, as I say, we don't have a network. This is a secondary policy, so it depends on if you're in, uh, network with a major medical.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK. All right. OK, can I just get a reference number for the call?
[AGENT][NEUTRAL] Uh, we don't give reference numbers, but if you like, you may use my name in today's date.
[CUSTOMER][NEUTRAL] OK, what's your name?
[AGENT][NEUTRAL] It's [PII], last [PII] [PII].
[CUSTOMER][NEUTRAL] OK
[CUSTOMER][POSITIVE] OK alright thank you so much have a good day.
[AGENT][POSITIVE] Alright, you too, Ms. [PII] and thank you for calling APL.
[CUSTOMER][POSITIVE] Thank you, thank you, bye bye.
[AGENT][NEUTRAL] Bye.