AccountId: 011433970860
ContactId: 0ba7e44b-607e-42d2-b617-af1adce19f95
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 378790 ms
Total Talk Time (AGENT): 188911 ms
Total Talk Time (CUSTOMER): 114085 ms
Interruptions: 1
Overall Sentiment: AGENT=0.7, CUSTOMER=1.3
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/05/19/0ba7e44b-607e-42d2-b617-af1adce19f95_20250519T17:09_UTC.wav
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[AGENT][NEUTRAL] Thank you for calling APL. This is [PII]. How can I help you?
[CUSTOMER][NEUTRAL] Yes ma'am, this is [PII] at Carolina Vision Associates in [PII]. I was just trying to verify medical benefits for a patient coming in for this afternoon.
[AGENT][POSITIVE] Sure, I can take benefits for you. Um, [PII], can I get a good call back number from you first in case we're disconnected please?
[CUSTOMER][NEUTRAL] Yes, it is area code [PII].
[AGENT][NEUTRAL] Thank you and then do you have the policy number?
[CUSTOMER][NEUTRAL] It is 610-114.
[AGENT][NEUTRAL] I'm sorry, [PII], could you repeat that please?
[CUSTOMER][NEUTRAL] Yeah, it is 610-114.
[AGENT][NEUTRAL] OK, one moment.
[AGENT][NEUTRAL] I heard 610-114, is that correct?
[CUSTOMER][NEUTRAL] Yes ma'am.
[AGENT][NEUTRAL] Uh, what was the name and date of birth for this number?
[CUSTOMER][NEUTRAL] It is [PII]. It is [PII].
[AGENT][NEUTRAL] OK, so that policy number you gave me is for a completely different number um do you maybe have their social I could search for them that way?
[CUSTOMER][NEUTRAL] No, ma'am, I don't.
[AGENT][NEUTRAL] OK, uh, the only other way I can search is, uh, if you wouldn't mind spelling out the first and last name for me.
[CUSTOMER][NEUTRAL] OK, it is [PII]
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] And then the last name is [PII]
[AGENT][NEUTRAL] OK thank you one moment.
[AGENT][NEUTRAL] And you did say this was [PII]?
[CUSTOMER][NEUTRAL] Yes ma'am.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] And uh [PII] was this for uh medical or dental?
[CUSTOMER][NEUTRAL] Medical.
[AGENT][NEUTRAL] Medical, OK, and if you would, I'm so sorry, could you verify her date of birth again?
[CUSTOMER][NEUTRAL] Yeah, it is [PII].
[AGENT][POSITIVE] Perfect. OK, thank you so much for verifying that. So I did find her policy with us. uh, let me know when you're ready and I can give that to you.
[CUSTOMER][POSITIVE] Yes ma'am, can I go ahead and get that?
[AGENT][NEUTRAL] Yes, that is 02.
[AGENT][NEUTRAL] 60.
[AGENT][NEUTRAL] 3885.
[CUSTOMER][POSITIVE] Perfect.
[AGENT][NEUTRAL] Yes, OK, and so this policy is active, uh, effective date was [PII], and, uh, this is a limited indemnity medical plan, uh, so it's pays a set dollar amount per covered, uh, procedure or office visit. Um, what kinds of benefits were we needing to check today?
[CUSTOMER][NEUTRAL] Um, just the specialist office visit either deductible or co-pay.
[AGENT][NEUTRAL] OK, so I can't, I will tell you this policy does not have, it's very different than traditional major medical, um, it does not have any co-pays or uh anything like that. Um, however, it is very limited as to what is and is not covered. So let me see if office visits are covered under this policy. One moment please.
[CUSTOMER][NEUTRAL] Oh.
[CUSTOMER][NEUTRAL] OK, yes ma'am.
[CUSTOMER][NEUTRAL] Uh
[AGENT][NEUTRAL] Alright, of course I will let you know verification of coverage is not a guarantee of payment for claims. Uh, so the, this number has for physician's office visit a maximum benefit of $50 per day, and that is the benefit amount that we would pay regardless of what they're being seen for. I will say if this is um is is this regarding uh wellness or is this regarding uh in a sickness or an injury?
[CUSTOMER][NEUTRAL] Um, no, ma'am, it's just a vision exam.
[AGENT][NEUTRAL] Oh, Vision.
[AGENT][NEUTRAL] You did say vision, I'm sorry.
[CUSTOMER][NEUTRAL] Yeah, yes, ma'am. I know she has vision insurance, but here we want to get the medical too in case like they, something was to go like medically wrong and the doctor um has to have anything medically.
[AGENT][NEUTRAL] No.
[AGENT][NEUTRAL] Oh.
[AGENT][NEUTRAL] Oh, I see. Yes.
[AGENT][NEUTRAL] OK, let me, give me just a moment because I don't know that this.
[CUSTOMER][NEUTRAL] yeah
[AGENT][NEUTRAL] Give me just a moment.
[CUSTOMER][NEUTRAL] Yes ma'am.
[AGENT][NEUTRAL] OK. So you mean like worst case scenario something happens, she has to go get emergency treatment.
[CUSTOMER][NEUTRAL] Well, like, yeah, or like if the doctor was to see the patient and they were to have like a medical diagnosis like cataracts, glaucoma, macular degeneration, anything like that, or they were to have like pink eye, then we have their medical insurance to go to.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] I see. OK, so I will say for this policy, again, this policy is a bit different than traditional major medical. So under the exclusions of this policy, it does mention uh vision services unless it was due to an injury, um, or if it was a a congenital defect or a birth anomaly of a newborn child. So this policy wouldn't really provide any benefits for vision.
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] Mhm
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Um, and then can I get a reference number for today?
[AGENT][NEUTRAL] Sure, it would just be my first name, last initial, and today's date. Uh so my name is spelled [PII], last initial is [PII] And did you have any other questions for me, [PII]?
[CUSTOMER][POSITIVE] I believe that is everything thank you so much.
[AGENT][POSITIVE] Of course, thanks for calling APL. I hope you have a great rest of your day.
[CUSTOMER][POSITIVE] Thank you, you too.
[AGENT][POSITIVE] Thanks bye bye.
[CUSTOMER][POSITIVE] Thank you bye.