AccountId: 011433970860
ContactId: 1a09ee98-d77e-4979-a7fd-552935c93d03
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 441869 ms
Total Talk Time (AGENT): 175635 ms
Total Talk Time (CUSTOMER): 190713 ms
Interruptions: 0
Overall Sentiment: AGENT=0.7, CUSTOMER=0.1
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/06/16/1a09ee98-d77e-4979-a7fd-552935c93d03_20250616T20:37_UTC.wav
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[AGENT][POSITIVE] Good afternoon. Thank you for calling American Public Life. This is [PII]. How may I help you?
[CUSTOMER][NEUTRAL] Hi [PII], I hope I'm in the right, right area. I am calling from Doctor [PII]'s office, and I have a patient that I need to get benefits on.
[AGENT][NEUTRAL] May I have a policy number along with your name?
[CUSTOMER][NEUTRAL] Yeah my name's [PII] or [PII], whatever you wanna do and the policy number I have is D like David 43,730,780.
[AGENT][NEUTRAL] I do apologize, that is not our policy number. Can you spell the first and last name or either the social security number?
[CUSTOMER][NEUTRAL] The last name is [PII].
[CUSTOMER][NEUTRAL] And the birthday is [PII].
[AGENT][NEUTRAL] And what is the first name?
[CUSTOMER][NEUTRAL] [PII]
[AGENT][NEUTRAL] OK. And may I have a good callback number for you?
[CUSTOMER][NEUTRAL] Yeah, [PII].
[AGENT][POSITIVE] Thank you. One moment.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] I
[AGENT][NEUTRAL] And that is not pulling up. Do you by chance have the group number?
[CUSTOMER][NEUTRAL] Yeah, 943-7, it's for [PII] and then.
[CUSTOMER][NEUTRAL] Do you want me to get his social?
[AGENT][POSITIVE] Yes, if you have it. Yes, ma'am.
[CUSTOMER][NEUTRAL] OK, I have it [PII].
[AGENT][POSITIVE] Thank you, one moment, I'll get this pulled up.
[CUSTOMER][NEUTRAL] Shortcut.
[AGENT][NEUTRAL] And please be advised that verification of coverage does not guarantee the payment of a claim.
[AGENT][NEUTRAL] So the policy number will be 02487.
[CUSTOMER][NEGATIVE] Oh, so it was wrong.
[AGENT][NEUTRAL] Yes, ma'am. Once they come over into our system, they get a different policy number.
[CUSTOMER][NEUTRAL] That OK.
[CUSTOMER][NEUTRAL] OK, so I need to, when we process the claim, it needs to have the number that you're about to give me?
[AGENT][NEUTRAL] Yes, ma'am.
[CUSTOMER][POSITIVE] OK, I'm ready for that number. I'm sorry.
[AGENT][NEUTRAL] No, you're fine. It's 0248.
[AGENT][NEUTRAL] 7793.
[AGENT][NEUTRAL] And which benefit can I provide for you?
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Well, we need to do, are you here for a drug test here? When you see the doctor? OK, just sign in and have a seat, OK? Uh huh. Uh, we are gonna be getting like an office visit, labs, X-ray, surgical, and DME, and everything is billed as a PCP office visit.
[AGENT][NEUTRAL] OK, so under this plan, there is no office visit, nor do they have the office treatment benefit under this policy.
[CUSTOMER][NEUTRAL] They don't have the 4 visits per year at $10 a copay.
[AGENT][NEUTRAL] No, ma'am.
[AGENT][NEUTRAL] Not under this one. Let me see if the policy changed.
[AGENT][NEUTRAL] This hospital indemnity plan is very limited.
[CUSTOMER][NEUTRAL] Oh, I don't need the hospital. I need uh like regular medical benefits for a, a primary care doctor.
[AGENT][NEUTRAL] So
[AGENT][NEGATIVE] Right, correct. Some plans offer this one does not.
[AGENT][NEUTRAL] Some plants do have it.
[CUSTOMER][NEUTRAL] OK, so this patient.
[CUSTOMER][NEUTRAL] So this patient only has hospital coverage?
[AGENT][NEUTRAL] Correct. There is some outpatient sickness benefits in surgery. So if he had a surgery in the office, it will cover that, but nothing else for office visits.
[CUSTOMER][NEUTRAL] OK. Um, well, how does it cover a surgical? What does it do there?
[AGENT][NEUTRAL] So for any um surgery in an office, physician's office visit, it will allow $125 per day max one day per calendar year.
[CUSTOMER][NEUTRAL] 100 per day, 1 per year. OK, so I guess the lady I talked to before you, she didn't know because she's the one who gave me this phone number to call you. She was saying that she was saying it it's like $10 co-pay 4 visits a year only, and then she gave me the number to talk to you.
[CUSTOMER][NEUTRAL] So now, um, there's no coverage for a doctor's office visit. Is that right? Is that what you're saying?
[AGENT][NEUTRAL] Correct. Was that for wellness? Do they have a wellness plan which would be separate from this one?
[CUSTOMER][NEUTRAL] Well she said they have a MEC enhanced plan.
[AGENT][NEUTRAL] And that I'm not sure. Let me see if I can pull up any other policies. See, they have several plans, but as far as the medical, there's an accident, a disability, an accident.
[AGENT][NEUTRAL] The only medical that we have is this one.
[AGENT][NEUTRAL] And there's no office visit benefits under that one.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Mm.
[CUSTOMER][NEUTRAL] Because they have an insurance, the insurance card, and it says 90 degrees, benefits in a card and it says offices that co-pay $10 on the card that the patient has.
[AGENT][NEUTRAL] OK, so that could be for wellness because the benefits in the car, the administrator to the policy, once they come over to our side, they're issued the number that I just gave you ending in 793 and it has different benefits over under this policy.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] OK, how would I get those first benefits? Do you know who I would call?
[AGENT][NEUTRAL] Benefits in a card, which is where you just came from?
[AGENT][NEUTRAL] To verify if it's wellness or anything else because this side does not have office visit benefits.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][POSITIVE] OK thank you I'm gonna call them again.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] You want me to transfer you over?
[CUSTOMER][POSITIVE] Yeah, sure, that'll hel[PII]
[AGENT][NEUTRAL] OK, [PII], is there anything else I can help you with?
[CUSTOMER][NEGATIVE] No thank you.
[AGENT][POSITIVE] You're welcome and thank you for calling American Public Day. Have a great day. Bye-bye. I'll transfer you over.
[CUSTOMER][NEUTRAL] You too bye bye. OK.
[AGENT][NEUTRAL] Bye bye.
[CUSTOMER][NEGATIVE] You are on hold.