AccountId: 011433970860
ContactId: 0581e43b-8d61-4266-909d-5a6b7e90b359
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 718289 ms
Total Talk Time (AGENT): 193940 ms
Total Talk Time (CUSTOMER): 138135 ms
Interruptions: 0
Overall Sentiment: AGENT=0.9, CUSTOMER=0.2
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/04/09/0581e43b-8d61-4266-909d-5a6b7e90b359_20250409T17:06_UTC.wav
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[AGENT][NEUTRAL] Thank you for calling APL. This is [PII]. How may I help you?
[CUSTOMER][NEUTRAL] Hi, good afternoon. I'm calling from Doctor [PII]'s office. Uh, we have a patient who has, um, this insurance, and we wanted to know if this visit for today's specialist specialist visit, his co-pay would be covered.
[AGENT][POSITIVE] Yeah, sure. I can help you with that today.
[AGENT][NEUTRAL] Do you have the patient's policy number?
[CUSTOMER][NEUTRAL] Yes, um, 0 whenever you're ready.
[AGENT][POSITIVE] OK, I'm ready.
[CUSTOMER][NEUTRAL] 02505749 M as in Mary, L as in Larry 8 the number 8.
[AGENT][POSITIVE] OK, thank you.
[AGENT][NEUTRAL] And then what's a good call back number in case our call gets dropped?
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] [PII].
[CUSTOMER][NEUTRAL] 0112
[AGENT][POSITIVE] OK, thank you.
[AGENT][NEUTRAL] OK, and patient's first and last name and then date of birth?
[CUSTOMER][NEUTRAL] First is [PII]. Date of birth [PII].
[AGENT][POSITIVE] OK, thank you.
[CUSTOMER][NEUTRAL] Oh
[AGENT][NEUTRAL] OK, just one moment.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] OK, can I put you on a brief hold while I look uh deeper into their policy?
[CUSTOMER][NEUTRAL] Yeah, that's fine.
[AGENT][POSITIVE] OK. OK, thank you.
[CUSTOMER][NEGATIVE] You are on hold.
[AGENT][NEUTRAL] OK, let's see.
[CUSTOMER][NEGATIVE] You are on hold.
[AGENT][NEUTRAL] OK, thank you for holding. So it looks like for the patient, they have an office visit writer, so for a physician's office.
[AGENT][NEUTRAL] They have up to $25 per visit, and that's a maximum of 4 visits per covered person per calendar year.
[AGENT][NEUTRAL] And then
[AGENT][NEUTRAL] They also have a specialist office visit. If this is a specialist office, it's up to
[CUSTOMER][POSITIVE] Yeah, this is special.
[AGENT][NEUTRAL] OK, so it would be up to $50 per visit, maximum of 4 visits per covered person per calendar year.
[CUSTOMER][NEUTRAL] OK, so today his copay is $60 so he would only be charged $10.
[AGENT][NEUTRAL] Um, I can't
[CUSTOMER][NEUTRAL] Like would he have to pay the $10?
[AGENT][NEUTRAL] So, I can't guarantee the payment. It's just a verification of coverage. So this is, I'm just going by what his policy says.
[CUSTOMER][NEUTRAL] OK, but OK, so I just wanna make sure, so you, you said $50 per visit, right?
[AGENT][NEUTRAL] Yes.
[CUSTOMER][NEUTRAL] OK, so if you guys cover $50 then you would have to just pay $10 today.
[CUSTOMER][NEUTRAL] Just by where you're going based off of.
[AGENT][NEUTRAL] I would just submit the claim. Um, I just can't guarantee the payment. I can just go based off of his policy and it does state that the specialist office visit is up to $50 per visit.
[CUSTOMER][NEUTRAL] OK, give me 1 2nd.
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Hi, thank you for holding. Can I know the patient's um amount balance that he has that he has and what he has used?
[AGENT][NEUTRAL] Let me see, just one moment.
[CUSTOMER][NEUTRAL] And
[CUSTOMER][NEUTRAL] Yes.
[CUSTOMER][NEUTRAL] Well
[CUSTOMER][NEUTRAL] No
[CUSTOMER][NEUTRAL] Any
[CUSTOMER][NEUTRAL] No
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] OK, so it looks like he.
[CUSTOMER][NEUTRAL] And we do
[AGENT][NEUTRAL] Has used the physician benefit just one time.
[AGENT][NEUTRAL] And then an outpatient benefit as well. So he has, according to his policy.
[AGENT][NEUTRAL] Hold on, let me go back.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] So according to his policy, the specialist office visit, so he has a maximum of 4 visits per covered person per calendar year.
[CUSTOMER][NEUTRAL] OK, and how many has he used?
[AGENT][NEUTRAL] 2.
[CUSTOMER][NEUTRAL] 2, so he has 2 more.
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] And it doesn't tell you like an amount like for example let's say he has like $1000 and he's used like $800. Do you have anything that says that?
[AGENT][NEUTRAL] So he has an outpatient benefit amount.
[AGENT][NEUTRAL] Which is the outpatient benefit amount is $2500 per covered person per calendar year.
[CUSTOMER][NEUTRAL] Yeah
[CUSTOMER][NEUTRAL] And how much has he accumulated already like used?
[AGENT][NEUTRAL] Let's see, the outpatient amount.
[AGENT][NEUTRAL] Uh, I'm not allowed to disclose the exact amount that he has used.
[AGENT][NEUTRAL] Um, I can just tell you that he has used his benefit twice.
[CUSTOMER][NEUTRAL] This
[CUSTOMER][NEUTRAL] Oh, OK, OK, that's fine. I understand what you're trying to say, OK.
[AGENT][NEUTRAL] Oh, I'm sorry I'm sorry, I can't. I, I told you wrong. Um, so the outpatient amount that he has used is only $75.
[CUSTOMER][POSITIVE] OK, perfect.
[AGENT][NEUTRAL] Sorry.
[CUSTOMER][NEUTRAL] No, no, it's fine.
[CUSTOMER][NEUTRAL] OK, alrighty, and outpatient is, um, it goes towards specialist visit, correct? Oh yeah, we're outpatient.
[AGENT][POSITIVE] Mhm. Correct.
[CUSTOMER][NEUTRAL] OK, alrighty, can I have a reference number for the call?
[AGENT][NEUTRAL] Of course, it's Hailey, H A.
[AGENT][NEUTRAL] L E Y
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] Last initial H and then today's date and is this service in office, right?
[CUSTOMER][NEUTRAL] Yeah, this is an office.
[AGENT][NEUTRAL] OK, it's a, it's a specialist office visit.
[CUSTOMER][NEUTRAL] Specialist, yes.
[AGENT][NEUTRAL] OK, so the outpatient benefit would not apply for the specialist office visit.
[CUSTOMER][NEUTRAL] Oh, would not apply? OK.
[AGENT][NEUTRAL] No, so it would just be the $50 per visit for the maximum of 4 visits. Yeah.
[CUSTOMER][NEUTRAL] Right, and he's already used to.
[CUSTOMER][NEUTRAL] OK
[AGENT][NEUTRAL] Yes, he has already used 2.
[CUSTOMER][POSITIVE] OK perfect thank you.
[AGENT][NEUTRAL] OK, of course. Is there anything else I can help you with?
[CUSTOMER][POSITIVE] No, that's all my love thank you I appreciate it.
[AGENT][POSITIVE] OK, yeah, of course, have a good day and thank you for calling APL.
[CUSTOMER][NEUTRAL] You too bye bye.
[AGENT][NEUTRAL] Mhm. Bye.