AccountId: 011433970860
ContactId: 0af0135b-8f38-42dd-b643-c61928438dc4
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 349829 ms
Total Talk Time (AGENT): 159830 ms
Total Talk Time (CUSTOMER): 91152 ms
Interruptions: 0
Overall Sentiment: AGENT=1.4, CUSTOMER=0.8
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/01/16/0af0135b-8f38-42dd-b643-c61928438dc4_20250116T20:10_UTC.wav
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[AGENT][NEUTRAL] Afternoon. Thank you for calling APL. My name is [PII]. How may I help you?
[CUSTOMER][NEUTRAL] Hopefully so this is [PII] last name initial [PII]. How are you doing today?
[AGENT][POSITIVE] I'm doing well, thank you for asking, [PII]. How are you today?
[CUSTOMER][POSITIVE] I'm doing good also, thank you.
[AGENT][POSITIVE] I'm good. How can I help you?
[CUSTOMER][NEUTRAL] Um, I was calling to get some information on some eligibility and benefits for a patient.
[AGENT][POSITIVE] It would be my pleasure to assist you, [PII]. What is a good callback number in case we get disconnected, please?
[CUSTOMER][NEUTRAL] That's [PII].
[AGENT][NEUTRAL] Thank you, [PII]. And what is the policy number for the patient?
[CUSTOMER][NEUTRAL] That is 60801.
[AGENT][NEUTRAL] That is actually our payer ID number.
[AGENT][NEUTRAL] Do you have a policy cert number listed for the patient?
[CUSTOMER][NEUTRAL] And uh
[CUSTOMER][NEUTRAL] Um, no, actually, that was the insurance ID number was provided to me.
[AGENT][NEUTRAL] OK, what is the last name of the patient? I can do a name search.
[CUSTOMER][NEUTRAL] That's [PII].
[AGENT][NEUTRAL] You wanna spell it?
[CUSTOMER][NEGATIVE] Yeah, that's [PII].
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] Alright, and the first name please?
[CUSTOMER][NEUTRAL] Um, [PII].
[AGENT][NEUTRAL] OK
[AGENT][NEUTRAL] And what is [PII]'s date of birth?
[CUSTOMER][NEUTRAL] [PII]'s date of birth is [PII].
[AGENT][POSITIVE] All right, thank you. I do have her policy pulled up and I'll be happy to provide information for you, [PII]. You ready for her policy number?
[CUSTOMER][POSITIVE] And yes I am ready.
[AGENT][NEUTRAL] And the policy number for [PII] is 249.
[AGENT][NEUTRAL] 4316.
[CUSTOMER][NEUTRAL] OK, got it.
[AGENT][NEUTRAL] And her policy is active as of [PII].
[AGENT][NEUTRAL] And this is a secondary policy to her major medical.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] And you were needing specific benefits?
[CUSTOMER][NEUTRAL] Uh, yes, but before that, is this, is, would this plan fall under an HMO EPO PPO plan?
[AGENT][NEUTRAL] No, it's just a secondary policy like a supplemental.
[CUSTOMER][POSITIVE] OK, it's like a supplement. Got it.
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] And does the plan have a group number?
[AGENT][NEUTRAL] Does have a group number and that group number is
[AGENT][NEUTRAL] 242-41.
[CUSTOMER][NEUTRAL] OK, got it. And for the benefits, I wanted to check office visits with the specialist and I don't know if you work with CPT codes or I just tell you the name of the procedures.
[AGENT][NEUTRAL] Yeah, so this policy does not cover the office visit. It does cover procedures or treatments performed in the office for sickness or injury.
[AGENT][NEGATIVE] But no benefits for the office visit itself.
[CUSTOMER][NEUTRAL] OK. So would there be benefits for allergy treatments?
[AGENT][NEUTRAL] It would. this policy pays towards sickness or injury, and allergies is considered a sickness. So the procedures or treatments for diagnostic testing in office would be covered under her outpatient benefit.
[AGENT][NEUTRAL] And that benefit max is $500 per calendar day.
[CUSTOMER][NEUTRAL] OK, so there's no copay, no deductible, it's just gonna be covered up to $500 right?
[AGENT][NEUTRAL] That's right, and we pay toward her deductible co-pay or co-insurance of her major medical.
[AGENT][NEUTRAL] And if you'd also note, [PII], that is a verification of coverage, not a guarantee of payment.
[CUSTOMER][NEUTRAL] OK, got it.
[CUSTOMER][NEUTRAL] Let me write that down.
[CUSTOMER][NEUTRAL] And referrals are not gonna be required, correct?
[AGENT][POSITIVE] That is correct. It is not required.
[CUSTOMER][NEUTRAL] No
[CUSTOMER][NEUTRAL] OK and uh can I get a claims address?
[AGENT][NEUTRAL] Sure, claims can be sent to [PII].
[AGENT][NEUTRAL] [PII].
[AGENT][NEUTRAL] [PII].
[AGENT][NEUTRAL] [PII].
[AGENT][NEUTRAL] And the zip code is [PII].
[CUSTOMER][NEUTRAL] OK, got it. Now I'm all set. All I need is a reference number for the call.
[AGENT][NEUTRAL] Reference number would be my name in today's date.
[AGENT][NEUTRAL] And I can spell my name for you.
[AGENT][NEUTRAL] It is [PII].
[AGENT][POSITIVE] And it's been a pleasure to help you with those benefits today, [PII]. Is there anything else I can help you with today?
[CUSTOMER][POSITIVE] Thank you, [PII]. No, that would be it.
[AGENT][POSITIVE] Well thank you for calling APL. I hope you have a wonderful afternoon.
[CUSTOMER][POSITIVE] You too have a good one.
[AGENT][POSITIVE] You too. Thank you.