AccountId: 011433970860
ContactId: 206f4ca0-dc47-4308-9915-c0cb18541305
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 254479 ms
Total Talk Time (AGENT): 78780 ms
Total Talk Time (CUSTOMER): 145644 ms
Interruptions: 1
Overall Sentiment: AGENT=0.5, CUSTOMER=-0.2
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/06/11/206f4ca0-dc47-4308-9915-c0cb18541305_20250611T20:04_UTC.wav
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[AGENT][NEUTRAL] For calling American Public Life. This is [PII]. How can I help you?
[CUSTOMER][NEUTRAL] Uh yes, hi, my name is [PII], and I'm calling you from provider's office. This is regarding the benefits for our patient. Um, is it, is this medical line?
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] Is this, I'm sorry?
[CUSTOMER][NEUTRAL] It's uh like you deal with the benefits for medical, right? Outpatient benefits, OK, OK, thank you.
[AGENT][NEUTRAL] What
[AGENT][NEUTRAL] Yes.
[AGENT][NEUTRAL] Yes, ma'am. OK. What is a good callback number for you, [PII]?
[CUSTOMER][NEUTRAL] [PII]
[AGENT][NEUTRAL] Thank you. The policy number you're calling on?
[CUSTOMER][NEUTRAL] Uh yes, that is 02.
[CUSTOMER][NEUTRAL] 579-427 [PII].
[CUSTOMER][NEUTRAL] Number 8.
[AGENT][NEUTRAL] Patient's name and date of birth?
[CUSTOMER][NEUTRAL] Um, it's [PII], uh, [PII], and, uh, date of birth is [PII].
[AGENT][NEUTRAL] OK, thank you so much for verifying the policy and you did say outpatient benefits today. Please be advised verifying benefits does not guarantee payment. The policy has been effective since 121 of 24. It is still active. For outpatient benefits, the policy pays up to $2500 a calendar year. I show the full amount is available at this time. Is there anything else I can help you with?
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] OK. Uh, I need a little bit of information one by one. number one, I need out of network benefits, uh, and specialty physical therapy. And secondly, I need, uh, like deductible, remaining deductible individual and family for this member.
[CUSTOMER][NEUTRAL] And I also need co-insurance and copays if there is any co-pay for out of network or co-insurance, so I need this information. And also if you can help me with like reimbursement rate, like you're following usual customer rate or Medicare rates or whatsoever if you have this kind of information I need this information so deductible, co-pay, coinsurance.
[CUSTOMER][NEUTRAL] And any visit limits like 20 visits, 30 visits, something like this. So like this, this information is required for you.
[AGENT][NEUTRAL] OK, this is a supplemental gap policy.
[AGENT][NEUTRAL] It is a $1 amount, a calendar year amount.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] The policy pays up to $2500 a calendar year.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] There is no co-pay, there is no deductible.
[CUSTOMER][NEGATIVE] Uh, $2500 only, and more than this, you will not pay, right?
[AGENT][POSITIVE] Correct.
[CUSTOMER][NEUTRAL] OK, sorry, yeah.
[CUSTOMER][NEUTRAL] OK. And what about deductible?
[AGENT][NEUTRAL] There is no co-pay or deductible. It is only a paid dollar amount, $2500.
[CUSTOMER][NEUTRAL] OK. No, OK.
[CUSTOMER][NEUTRAL] No deductible. And $2500 will be paid by insurance, right, on planes.
[AGENT][NEUTRAL] I'm sorry?
[CUSTOMER][NEUTRAL] Uh, I wanna know this amount 2500, right? This is like reimbursement from insurance.
[AGENT][NEUTRAL] This is a supplemental gap policy.
[CUSTOMER][NEGATIVE] No, I'm not getting you. Uh, what is this 2500 for? Like, is this amount would be?
[AGENT][NEUTRAL] That is the calendar year amount paid towards outpatient services.
[CUSTOMER][NEUTRAL] Oh, OK. OK. All right.
[CUSTOMER][NEUTRAL] OK, so
[CUSTOMER][NEUTRAL] OK $2500 per year. OK. And there is no co-pay, no deductible, and anything about co-insurance?
[AGENT][NEUTRAL] No, ma'am.
[CUSTOMER][NEUTRAL] No for insurance. OK. All right. That's it.
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK.
[AGENT][POSITIVE] You have a wonderful day. Thank you for calling APL.
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][POSITIVE] Um, thank you. You too.
[AGENT][NEUTRAL] Bye bye.