AccountId: 011433970860
ContactId: 027b554e-b839-4601-84c0-af5d4d1a1092
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 338450 ms
Total Talk Time (AGENT): 137677 ms
Total Talk Time (CUSTOMER): 103265 ms
Interruptions: 1
Overall Sentiment: AGENT=0.9, CUSTOMER=1
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/03/24/027b554e-b839-4601-84c0-af5d4d1a1092_20250324T16:57_UTC.wav
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[AGENT][NEUTRAL] Thank you for calling APL. This is [PII]. How may I help you?
[CUSTOMER][NEUTRAL] Hello, good afternoon. I'm calling from a provider's office. I wanted to check benefits for a patient.
[AGENT][NEUTRAL] OK, I can help you with the benefits. Can I please get your name and your call back number and the provider's office you're calling from?
[CUSTOMER][NEUTRAL] Yes, I'm calling from Valley D I Clinic. Um, my name would be [PII], that's spelled [PII] and initial to my last would be [PII]. For the good call back number would be [PII] and it'll be, it would be a direct line. Um, you said your name was [PII]?
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] Yes, ma'am.
[AGENT][NEUTRAL] And I got the valley part of your facility. What was the second part, Valley?
[CUSTOMER][NEUTRAL] Valley Day and night clinic.
[AGENT][NEUTRAL] Day and night clinic. OK, thank you very much, Ms. [PII]. OK, and what is the patient's name, date of birth, and policy number?
[CUSTOMER][NEUTRAL] [PII], date of birth is [PII].
[CUSTOMER][NEUTRAL] And what else? I'm sorry?
[AGENT][NEUTRAL] The policy number?
[CUSTOMER][NEUTRAL] The policy number would be.
[CUSTOMER][NEUTRAL] 01868897
[AGENT][NEUTRAL] OK, let me look up the policy real quick.
[AGENT][NEUTRAL] OK, and this is just to verify the benefits. It's not a guarantee of payment. She has an active policy. The effective date of the policy is [PII].
[AGENT][NEUTRAL] And this is a supplemental policy that's billed secondary to the primary. It's a gap insurance that helps with deductible, co-pay, and co-insurance.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] That's
[CUSTOMER][NEUTRAL] And they put it on me.
[AGENT][NEUTRAL] She has an inpatient benefit amount per calendar year of $2550 but then she also has an outpatient calendar year benefit amount of $2550 to go towards deductible, co-pay or co-insurance.
[CUSTOMER][NEUTRAL] OK, so then it's just um the total that they have.
[CUSTOMER][NEUTRAL] Um, I guess to be covered.
[AGENT][NEUTRAL] Right, that's
[AGENT][NEUTRAL] Benefi amount is $2550 and once that $2550 is exhausted then.
[CUSTOMER][NEUTRAL] 2500.
[AGENT][NEUTRAL] Then it's gone for the year.
[CUSTOMER][NEUTRAL] OK, and how much have they used?
[AGENT][NEUTRAL] Uh, she has used only $10 on her outpatient benefit.
[AGENT][NEUTRAL] Nothing on the end patient.
[CUSTOMER][NEUTRAL] I
[CUSTOMER][NEUTRAL] Alright.
[CUSTOMER][NEUTRAL] OK, um, and then would I be able to like obtain like a specific.
[CUSTOMER][NEUTRAL] Benefits to like an office visit or it's just based on that 2550?
[AGENT][NEUTRAL] It's based on that 2550 as far as the benefit amount per calendar year. Let me look and see if she does have office visits or not.
[AGENT][NEUTRAL] I'm gonna pull her policy up real quick and read it and see what it says.
[CUSTOMER][POSITIVE] Thank you.
[AGENT][POSITIVE] You're welcome.
[AGENT][NEUTRAL] Give me just a sec while the computer loads it up for us.
[CUSTOMER][POSITIVE] It's all right.
[AGENT][NEUTRAL] Uh, she does not have office visits on this policy.
[CUSTOMER][NEUTRAL] But it would cover if the primary were to she were were to have like any copay for an office visit, correct?
[AGENT][NEUTRAL] Right, the office visits are not covered under this policy.
[CUSTOMER][NEUTRAL] So for example if the primary um with the primary she has a copay, um.
[CUSTOMER][NEUTRAL] With American Public Health, it wouldn't be covering that copay?
[AGENT][POSITIVE] Correct.
[AGENT][NEUTRAL] She has an office treatment writer which will help with the office visit, but as far as the physician's fee, it is not covered.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Alright, I just need a reference number please.
[AGENT][NEUTRAL] Yes ma'am, you can use my name [PII] and today's date.
[CUSTOMER][NEUTRAL] So it's [PII] and today's date?
[AGENT][NEUTRAL] Yes ma'am.
[CUSTOMER][POSITIVE] OK perfect alright thank you so much for your help, [PII] that would be all.
[AGENT][POSITIVE] You're very welcome, Ms. [PII]. I hope you have a wonderful day and thank you for calling APL.
[CUSTOMER][POSITIVE] Thank you likewise see you bye bye.
[AGENT][POSITIVE] Thank you. Bye-bye, ma'am.