AccountId: 011433970860
ContactId: 157590ad-8c15-4488-a466-ee4e7ccb72aa
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 227919 ms
Total Talk Time (AGENT): 132627 ms
Total Talk Time (CUSTOMER): 66795 ms
Interruptions: 0
Overall Sentiment: AGENT=1.3, CUSTOMER=1.5
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/05/06/157590ad-8c15-4488-a466-ee4e7ccb72aa_20250506T14:24_UTC.wav
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[AGENT][POSITIVE] Good morning. Thank you for calling APL. This is [PII]. How may I help you today?
[CUSTOMER][NEUTRAL] Uh, hi, good morning. My name is [PII]. Um, I was calling because, uh, a patient came with this insurance.
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] And I just want to know if we accept this insurance if we are in network and if they, if you cover uh office visits, like VCP visits.
[AGENT][POSITIVE] OK. All right, I'll be glad to help you, but I am so sorry I did not catch your name.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Uh, my name is [PII]
[AGENT][NEUTRAL] All right. Well, thank you for that. Now, member's policy number, please, sir.
[CUSTOMER][NEUTRAL] It's.
[CUSTOMER][NEUTRAL] Uh
[CUSTOMER][NEUTRAL] Let me see, 022.
[CUSTOMER][NEUTRAL] 30146
[CUSTOMER][NEUTRAL] M as in Mary, L as Laura, 7.
[AGENT][NEUTRAL] Alrighty, well, thank you for all that information. Now, while I'm pulling this up, go ahead and give me a good return telephone call number.
[CUSTOMER][NEUTRAL] Uh yes, it's [PII].
[AGENT][POSITIVE] Alrighty, thank you so much, [PII], for all that information. Now your patient's name and date of birth today, please, sir?
[CUSTOMER][NEUTRAL] It da da da like.
[CUSTOMER][NEUTRAL] Uh, Payton Bay. I, I think that's how you pronounce it.
[CUSTOMER][NEUTRAL] And date of birth is [PII].
[AGENT][NEUTRAL] Alrighty, well, thank you for all that information. Now it looks like [PII] is a dependent on this medical supplemental plan. I do show his original effective date is [PII]. Patient is current and active, but I must advise that verification of coverage is not a guarantee of payment on the claim, but you did say you want office office visit benefits and see about the network, correct?
[CUSTOMER][POSITIVE] Correct.
[AGENT][NEUTRAL] All right, now [PII], I mean, what we are for [PII] is the medical supplemental plan. So the only thing that we would pick up and pay for is anything for sickness and injury that is applied towards patients deductible, co-pay, or co-insurance at the primary insurance carrier, um, because we are just a supplemental plan. He has a primary uh carrier or somewhere else.
[AGENT][NEUTRAL] But there's no PPO network we just coordinate with that primary.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] But as far as the office visit charge, that there's no office visit charge benefits under this plan, but there is office treatment. What that means is if he goes to the office visit, the office visit charge is not covered, but if he has X-ray and lab done in the office, that would be um something that we would look at at processing, and that benefit is going to be a zero deductible, and they have a $1000 per calendar year benefit here for those services.
[CUSTOMER][NEUTRAL] OK, understood. uh, let me put this in my notes.
[AGENT][NEUTRAL] Yes, sir.
[CUSTOMER][NEUTRAL] Mhm
[CUSTOMER][NEUTRAL] OK. And do you have a reference number of this call so I can put it in my notes?
[AGENT][NEUTRAL] Hello.
[AGENT][NEUTRAL] Is that all that I can help answer for you today, Raul?
[CUSTOMER][POSITIVE] Uh, yes, yes, that will be all. Thank you.
[AGENT][NEUTRAL] Oh right, we don't, yes, sir. Well, we don't give reference numbers, but you can use my name in today's date and my name is [PII] spelled [PII]
[CUSTOMER][POSITIVE] OK, great. Thank you very much. That, that will be all. Thank you for your time.
[AGENT][POSITIVE] Alright, yes, sir, and thank you for calling APLO. Have a good day.
[CUSTOMER][POSITIVE] Have an excellent day bye bye.
[AGENT][NEUTRAL] Bye bye.