AccountId: 011433970860
ContactId: 0ef91bfc-3465-49e7-8849-253a9e6af25e
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 180880 ms
Total Talk Time (AGENT): 88718 ms
Total Talk Time (CUSTOMER): 69966 ms
Interruptions: 0
Overall Sentiment: AGENT=1.1, CUSTOMER=0.9
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/06/19/0ef91bfc-3465-49e7-8849-253a9e6af25e_20250619T20:27_UTC.wav
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[AGENT][POSITIVE] Good afternoon. Thank you for calling APL. My name is [PII]. How may I help you?
[CUSTOMER][NEUTRAL] Hello, [PII]. This is [PII] with Doctor [PII] cardiologist. I was calling to just verify benefits on a patient. Uh, she called us, uh, the secondary policy. I wanna make sure it's active and what the benefits are.
[AGENT][NEUTRAL] OK, well I can help you with the eligibility and benefits, and may I have a good contact number in case we're disconnected, [PII]?
[CUSTOMER][NEUTRAL] Sure. It's [PII].
[AGENT][NEUTRAL] Thank you. And may I have the member's policy number?
[CUSTOMER][NEUTRAL] Yes, it's 01868793.
[AGENT][NEUTRAL] Thank you, hold on one moment.
[AGENT][NEUTRAL] And can you verify the member's first and last name and date of birth?
[CUSTOMER][NEUTRAL] Yes, it's [PII], uh [PII].
[AGENT][NEUTRAL] Thank you for that and all the information provided is a verification of benefits, not a guarantee of payment, and I am showing that the policy is active. It's been effective since [PII].
[AGENT][NEUTRAL] And did you need outpatient benefits?
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Yes.
[AGENT][NEUTRAL] OK, hold on one moment.
[CUSTOMER][NEUTRAL] It's for like for office visit and in case the doctor orders diagnostic testing. She does have Blue Cross primary. This would be the, the pick up like secondary benefits. Yeah, OK.
[AGENT][NEUTRAL] Second
[AGENT][NEUTRAL] Mhm.
[AGENT][NEUTRAL] Let me double check Blue Cross. Yeah.
[AGENT][NEUTRAL] And for the benefits, the policy will pay up to, hold on one moment, waiting for it to come up. Sorry.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] I want to check on the
[AGENT][NEUTRAL] Alright, so for outpatient, the policy will pay up to $2550 per calendar year.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] Now for the office setting.
[CUSTOMER][NEUTRAL] So
[CUSTOMER][NEUTRAL] Yes, uh huh, go ahead.
[AGENT][NEUTRAL] For the office setting, there is no coverage for the office setting if you were to use 99213, 99214 like place of service codes, but there is an office treatment rider, so the treatment that's done in the office could be covered up to that 2550 per year.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] OK. So for an office visit, there's no, no benefit for an office visit. But if the doctor was to order a diagnostic testing, which we do in office, that might be covered, but not, not, uh, not an encounter, not a visit. OK. That's what I needed to know. She's coming in tomorrow for a visit, so I'll have to let her know that that there's no benefit for tomorrow. OK. OK, well then, then that's fine. Um, can I have a reference number for this phone call?
[AGENT][NEUTRAL] Right.
[AGENT][POSITIVE] Exactly.
[AGENT][NEUTRAL] Yes.
[AGENT][NEUTRAL] You're very welcome. Um well, there's no call reference number, but you can use my name in today's date. And again, that's [PII], first initial of my last name is [PII].
[CUSTOMER][POSITIVE] OK. OK. Well, thank you so much, [PII].
[AGENT][POSITIVE] You're very welcome and thanks for calling APL. I hope you have a great day.
[CUSTOMER][POSITIVE] Thanks you too. Thanks. Bye-bye.
[AGENT][POSITIVE] Thank you. Bye-bye.