AccountId: 011433970860
ContactId: 1720972f-33d4-4fbd-865a-596f60e5a6aa
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 258510 ms
Total Talk Time (AGENT): 133184 ms
Total Talk Time (CUSTOMER): 86025 ms
Interruptions: 1
Overall Sentiment: AGENT=1.4, CUSTOMER=1
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/03/31/1720972f-33d4-4fbd-865a-596f60e5a6aa_20250331T20:47_UTC.wav
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[AGENT][POSITIVE] Good afternoon. Thank you for calling APO. This is [PII]. How may I assist you?
[CUSTOMER][NEUTRAL] Hello, good afternoon. I'm calling from the provider's office. I wanted to check benefits for patients.
[AGENT][POSITIVE] Yeah, sure, I can assist you with the benefits and may I have your name?
[CUSTOMER][NEUTRAL] [PII]?
[AGENT][NEUTRAL] OK. Thank you, Ms. [PII]. And may I have a callback number just in case we get disconnected?
[CUSTOMER][NEUTRAL] [PII] and it would be a direct line.
[AGENT][NEUTRAL] OK, thank you. And may I have the patient's policy number?
[CUSTOMER][NEUTRAL] That would be 02583503.
[CUSTOMER][NEUTRAL] Um.
[AGENT][NEUTRAL] OK, um, one moment.
[CUSTOMER][NEUTRAL] Uh, do you have any.
[AGENT][NEUTRAL] And may I have the name?
[CUSTOMER][NEUTRAL] I'm seeing that the card says.
[CUSTOMER][NEUTRAL] For the patient [PII].
[AGENT][NEUTRAL] Mm
[AGENT][NEUTRAL] Yes.
[AGENT][NEUTRAL] OK, and what's the date of birth?
[CUSTOMER][NEUTRAL] That would be [PII].
[AGENT][NEUTRAL] OK, perfect. Thank you. And you said you need um benefits and eligibility or claim status?
[CUSTOMER][NEUTRAL] Benefits and eligibility.
[AGENT][NEUTRAL] OK. All right.
[CUSTOMER][NEUTRAL] For, for medical, I don't know if they have medical benefits.
[AGENT][NEUTRAL] Mhm. Yes. Um, let me go ahead and give you the benefits. And what type of service is being rendered?
[CUSTOMER][NEUTRAL] For office visit under PCP office?
[AGENT][NEUTRAL] OK. All right. Before I give you any benefit information, I need to let you know that this is not a guarantee of payment, just a verification of coverage. And this is one of our secondary supplemental plan to the major medical. And let me go ahead and pull the benefits and see if it covers in office, OK? One moment.
[CUSTOMER][POSITIVE] Thank you.
[AGENT][POSITIVE] You're welcome.
[CUSTOMER][NEUTRAL] the
[CUSTOMER][NEUTRAL] Yeah
[CUSTOMER][NEUTRAL] Um
[CUSTOMER][NEUTRAL] No
[AGENT][NEUTRAL] All right.
[CUSTOMER][NEUTRAL] All right
[AGENT][NEUTRAL] OK, we have an effective date of [PII]. It is active at the moment. And this one covers office treatments or office procedures, but it does not cover the co-payment for the office visit.
[CUSTOMER][NEUTRAL] OK, so then.
[CUSTOMER][NEUTRAL] So it's a secondary so if they have a copy with the primary they would have to pay that out of pocket and but it would be covering any anything else done in office.
[AGENT][NEUTRAL] Mhm.
[AGENT][POSITIVE] Mhm. Correct.
[AGENT][NEUTRAL] It will cover any procedures done in office, like if they have to have an X-ray, ultrasound, sonogram, um, injections, uh small surgery, uh, anything like that will be, um, a test, a lab work. Anything like that inside of the office will be considered. The only thing we do not cover is the visit itself. So anything 99213, 99214, anything like that will not be covered because that's an office visit. Office visits are not covered.
[CUSTOMER][NEUTRAL] I
[CUSTOMER][NEUTRAL] Yeah
[CUSTOMER][NEUTRAL] But let me.
[CUSTOMER][NEUTRAL] OK, so any labs done as well will be covered.
[AGENT][NEUTRAL] Mhm.
[AGENT][NEUTRAL] As long as it's done in the office and it's a procedure. Correct. Yes. Mhm.
[CUSTOMER][NEUTRAL] See if we can.
[CUSTOMER][NEUTRAL] I
[CUSTOMER][NEUTRAL] OK perfect you say your name was?
[AGENT][NEUTRAL] My name is [PII]. That's [PII]. And do you need the benefit amount for outpatient?
[CUSTOMER][NEUTRAL] Yes.
[AGENT][NEUTRAL] OK, the outpatient maximum is 2550 per covered person per calendar year.
[CUSTOMER][NEUTRAL] OK, perfect. I'm just gonna need a reference number please.
[AGENT][NEUTRAL] We don't have reference numbers. You can use my name in today's date if you will.
[CUSTOMER][POSITIVE] OK, perfect.
[AGENT][NEUTRAL] Mhm. Is there anything else?
[CUSTOMER][POSITIVE] OK, that will be all for today thank you so much for your help.
[AGENT][POSITIVE] You're welcome and thank you for calling APO. Have a good day.
[CUSTOMER][POSITIVE] Thank you likewise to you bye bye.
[AGENT][POSITIVE] Thank you. Bye-bye.