AccountId: 011433970860
ContactId: 0784c76d-6fa4-46c2-8f20-5c13a260e923
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 392510 ms
Total Talk Time (AGENT): 184791 ms
Total Talk Time (CUSTOMER): 99132 ms
Interruptions: 2
Overall Sentiment: AGENT=0.3, CUSTOMER=0.4
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/03/03/0784c76d-6fa4-46c2-8f20-5c13a260e923_20250303T17:21_UTC.wav
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[AGENT][POSITIVE] Good morning. Thank you for calling APL. This is [PII]. How may I assist you?
[CUSTOMER][NEUTRAL] Hello, this is [PII] calling from Pioneer Healthcare Clinic. I was just calling to see if we are in network with the patient's insurance and so if we are to get an effective day and co-payment.
[AGENT][NEUTRAL] OK, sure, I can assist you with that information, Miss [PII]. May I have a callback number just in case we get disconnected?
[CUSTOMER][NEUTRAL] Yes
[CUSTOMER][NEUTRAL] Uh, yes, the callback number is going to be [PII].
[CUSTOMER][NEUTRAL] [PII]
[AGENT][NEUTRAL] OK
[AGENT][POSITIVE] Thank you.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] And may I have the name of the?
[CUSTOMER][NEUTRAL] Can you go ahead and give me your name?
[AGENT][NEUTRAL] Oh sure, yes. My name is [PII]. It's OK. That's [PII]. That's initial [PII]. And what's the name of the facility you're calling from for my notation?
[CUSTOMER][NEUTRAL] Sorry.
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] It is Pioneer Healthcare Connect.
[AGENT][NEUTRAL] OK, and do you have a policy number for me?
[CUSTOMER][NEUTRAL] Um, it's gonna be 02.
[CUSTOMER][NEUTRAL] 566898
[AGENT][NEUTRAL] What's the name and date of birth of the patient?
[CUSTOMER][NEUTRAL] The name is gonna be for [PII].
[AGENT][NEUTRAL] What's your date of birth?
[CUSTOMER][NEUTRAL] Date of birth is going to be.
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] OK, thank you. All right, so let's see.
[AGENT][NEUTRAL] So this particular policy is a hospital indemnity plan.
[AGENT][NEUTRAL] With this one there's no network we just paid an indemnity amount which is a flat amount which is a limited amount um and this is considered, you said an office visit.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] OK. So this is not a guarantee of payment, just a verification of coverage and that's just a disclaimer. And with this one, let's see how much we cover. One moment.
[AGENT][NEUTRAL] And we have an effective date of [PII] and it's still active at the moment and um.
[AGENT][NEUTRAL] I'm waiting on the benefits to pull up, bear with me.
[CUSTOMER][NEUTRAL] So is this insurance just like for hospital or can he be seen as a PCP office?
[AGENT][NEUTRAL] Yeah, that's what I'm trying to see if he has coverage for office um.
[CUSTOMER][NEUTRAL] Um
[CUSTOMER][NEUTRAL] This is [PII] speaking. How can I help you today?
[AGENT][NEUTRAL] OK
[AGENT][NEUTRAL] so have the screening and
[CUSTOMER][NEUTRAL] OK
[AGENT][NEUTRAL] Patient physicians. OK, let me see what we have for office, OK.
[CUSTOMER][NEUTRAL] Oh
[CUSTOMER][NEUTRAL] What
[AGENT][NEUTRAL] Um
[CUSTOMER][NEUTRAL] So it says here that it says that you have 2 refills for that medication.
[AGENT][NEUTRAL] OK, so it looks like we cover $75 per visit. Um, let me see how many visits, um.
[CUSTOMER][NEUTRAL] Um, yes, for the [PII], the 10G tablet, that one you don't have no refills, but for the other one, you do.
[AGENT][NEGATIVE] I don't believe it for here.
[CUSTOMER][NEUTRAL] Mhm
[AGENT][NEUTRAL] Um, I don't see how many he can use a year. Bear with me.
[CUSTOMER][NEUTRAL] Yeah, I can go let her know.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] Up to 6 visits per year.
[AGENT][NEUTRAL] So the amount we pay is $75 per visit.
[CUSTOMER][NEUTRAL] OK, so what would be their co-payment for?
[AGENT][NEUTRAL] There's no co-payments, co-insurance, and deductible because this is an indemnity policy which is a a limited policy. We only pay that $75 any anything over or remaining as patients responsibility.
[CUSTOMER][NEUTRAL] OK. So there's no deductible.
[CUSTOMER][NEUTRAL] What is the payer ID?
[AGENT][NEUTRAL] Alright, for this one, let me go back to the home page, one moment.
[AGENT][NEUTRAL] Mhm
[AGENT][NEUTRAL] OK, the payer ID is 60801. Again, that's 60801.
[CUSTOMER][NEUTRAL] Do you have a payer address?
[AGENT][NEUTRAL] Yes, that is [PII].
[AGENT][NEUTRAL] [PII].
[AGENT][NEUTRAL] And the zip code is [PII].
[AGENT][NEUTRAL] [PII].
[CUSTOMER][NEUTRAL] Mm hm.
[CUSTOMER][NEUTRAL] OK, and can I get a confirmation number for this call?
[AGENT][NEUTRAL] We don't have reference numbers. You can use my name in today state if you will. You need the spelling of my name or any other information.
[CUSTOMER][NEUTRAL] OK, so yeah I do cover office visits, correct?
[AGENT][NEUTRAL] We do cover office visit and the amount that we cover is $75 per visit, maximum of 6 visits per cover person per calendar year.
[CUSTOMER][POSITIVE] OK, alrighty, thank you so much for your help.
[AGENT][POSITIVE] You're welcome and thank you for calling APO. Have a good day.
[CUSTOMER][POSITIVE] No problem.
[AGENT][NEUTRAL] Mm