AccountId: 011433970860
ContactId: 15b6791b-90cd-4439-b686-b9e3294124a5
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 229589 ms
Total Talk Time (AGENT): 127763 ms
Total Talk Time (CUSTOMER): 51180 ms
Interruptions: 0
Overall Sentiment: AGENT=0.7, CUSTOMER=1
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/01/17/15b6791b-90cd-4439-b686-b9e3294124a5_20250117T19:45_UTC.wav
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[AGENT][NEUTRAL] Thank you for calling APL. This is [PII]. How can I help you?
[CUSTOMER][NEUTRAL] Yes, hi, this is [PII] calling from provider's office. I'm calling to get benefits on a member.
[AGENT][POSITIVE] Yeah, I can check benefits for you, [PII]. Uh, can I get a good call back number from you first in case we're disconnected?
[CUSTOMER][NEUTRAL] [PII]
[CUSTOMER][NEUTRAL] [PII].
[AGENT][POSITIVE] Thank you.
[AGENT][NEUTRAL] OK, got it, thank you. And uh do you have the policy number?
[CUSTOMER][NEUTRAL] 1572909.
[CUSTOMER][NEUTRAL] M for Mary, L for Larry, 8.
[AGENT][NEUTRAL] Alright, thank you and what was the name and date of birth for the insured?
[CUSTOMER][NEUTRAL] [PII] [PII].
[AGENT][NEUTRAL] OK, thank you for verifying that [PII]. Uh, so this policy actually terminated [PII]. If you'll give me one moment, I'll see if they have one that's active. It might just be a different policy number.
[CUSTOMER][POSITIVE] Thank you.
[AGENT][NEUTRAL] OK, they do have one that is active, uh, let me know when you're ready for that policy number.
[CUSTOMER][POSITIVE] I'm ready.
[AGENT][NEUTRAL] OK, it is 02.
[AGENT][NEUTRAL] 53.
[AGENT][NEUTRAL] 82
[AGENT][NEUTRAL] 23.
[CUSTOMER][NEUTRAL] OK, and when did that become effective?
[AGENT][NEUTRAL] This policy's effective date was [PII].
[CUSTOMER][NEUTRAL] OK, and um that's secondary?
[AGENT][NEUTRAL] Yes, this is a secondary medical policy. It is designed to help with co-pay, deductible and co-insurance after major medical pays.
[CUSTOMER][NEUTRAL] OK, so it doesn't cover um offices is it.
[AGENT][NEUTRAL] Uh, let me see if office visits are covered under this policy.
[CUSTOMER][POSITIVE] Thank you.
[AGENT][NEUTRAL] Alright, of course I will let you know, [PII], verification of coverage is not a guarantee of payment for claims, uh, so the office visit itself would not be covered, however, treatment received in office could be.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] Their outpatient benefit is on a per calendar day basis, so it is $500 max per calendar day.
[CUSTOMER][NEUTRAL] And
[CUSTOMER][NEUTRAL] OK, so basically, um, no office visit just treatment or outpatient surgery?
[AGENT][NEUTRAL] Correct, well, and you know there could be other uh.
[AGENT][NEUTRAL] Options as well it's mainly you know if she went in just for like a consultation um then it wouldn't be able to pay anything but if she went to the office and received treatment that could be covered.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] And can I get a claims address please?
[AGENT][NEUTRAL] Yes, that address is [PII].
[AGENT][NEUTRAL] [PII].
[AGENT][NEUTRAL] And that is in [PII]?
[AGENT][NEUTRAL] [PII].
[AGENT][NEUTRAL] Zip code is [PII].
[AGENT][NEUTRAL] I've also got a fax number and a pair ID if you'd like [PII].
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Sure, the pay ID.
[AGENT][NEUTRAL] OK, yeah, payer ID is 60801.
[CUSTOMER][NEUTRAL] OK, and um can I get your name and a reference number?
[AGENT][NEUTRAL] Yeah, reference number would just be my first name, last initial, and today's date. Uh, so my name is spelled [PII] Was there anything else I could help you with, [PII]?
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][POSITIVE] That'd be all, thank you for your help.
[AGENT][POSITIVE] Alright, yeah, thanks for APL. Have a great weekend.
[CUSTOMER][NEUTRAL] You too bye bye.
[AGENT][NEUTRAL] Bye bye.