AccountId: 011433970860
ContactId: 0d78a3d3-626a-4a9e-b0d9-1ea86e20e039
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 231399 ms
Total Talk Time (AGENT): 99207 ms
Total Talk Time (CUSTOMER): 81510 ms
Interruptions: 0
Overall Sentiment: AGENT=1.7, CUSTOMER=2.4
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/03/06/0d78a3d3-626a-4a9e-b0d9-1ea86e20e039_20250306T17:04_UTC.wav
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[AGENT][NEUTRAL] Thank you for calling American Public Life. This is [PII]. How may I assist you?
[CUSTOMER][NEUTRAL] Hi, my name is [PII] and I'm calling with the provider's office. I'm just trying to verify eligibility and benefits. I'm not familiar with this plan, so I was wondering if I could get some information.
[AGENT][NEUTRAL] OK, may I have a callback number?
[CUSTOMER][NEUTRAL] On this plan for this patient.
[CUSTOMER][NEUTRAL] Yes, my direct line is [PII].
[AGENT][NEUTRAL] May I have the policy number?
[CUSTOMER][NEUTRAL] Yes, it's 02595355.
[AGENT][NEUTRAL] May I have the patient's name and date of birth?
[CUSTOMER][NEUTRAL] [PII], [PII].
[AGENT][NEUTRAL] And this is for medical benefits?
[CUSTOMER][POSITIVE] Correct.
[AGENT][NEUTRAL] And is this for office, inpatient, outpatient?
[CUSTOMER][NEUTRAL] It's for an outpatient office visit. I do have a couple of CPT codes, but I'm not sure if this is a secondary plan to his primary or what type of plan this is.
[AGENT][NEUTRAL] Yes, we're considered their supplemental to their primary insurance.
[CUSTOMER][NEUTRAL] OK.
[AGENT][POSITIVE] And I'm pulling the member's benefits up for you now.
[CUSTOMER][NEUTRAL] All right. Is this an HMO or uh what type of plan is this?
[AGENT][NEUTRAL] This policy is not considered a major medical. It's just based off of the the amount that they have with us and we will pay up to that benefit amount.
[CUSTOMER][NEUTRAL] OK, got you.
[CUSTOMER][NEUTRAL] Understand now.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] And in regards to this member's policy, verification of coverage does not guarantee the payment of the claim.
[AGENT][NEUTRAL] This policy is showing currently active. The effective date is [PII] for the office visit fee. This member does not have the office visit fee benefit rider, but for any procedure rendered within the office for sickness and injury, the member does have up to $6800 per calendar year with a $1500 deductible.
[AGENT][NEUTRAL] This will go towards, as I stated, the deductible co-insurance or co-pay for the primary. We do not cover anything for preventative or wellness.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Is there a way to check for CPT codes to see if they would be covered under this plan or no?
[AGENT][NEUTRAL] If the primary applies it to their deductible coinsurance or co-pay, and it is for sickness or injury.
[AGENT][NEUTRAL] Then it should be considered under this policy. Since we don't process claims over the phone, we don't verify codes.
[CUSTOMER][POSITIVE] OK, I got you. OK, thank you so much for verifying all this for me. I appreciate it so much.
[AGENT][POSITIVE] Oh, that's no problem. Is there anything else that I can assist you with today, [PII]?
[CUSTOMER][POSITIVE] No, that was all that I needed. Thank you.
[AGENT][POSITIVE] You're welcome. Thank you for calling American Public Life. You're welcome. Have a great day.
[CUSTOMER][POSITIVE] I appreciate it.
[CUSTOMER][POSITIVE] You as well thank you bye bye.
[AGENT][POSITIVE] Thank you, bye.