AccountId: 011433970860
ContactId: 24673875-2440-473a-a9cb-d84472ffe3a6
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 224729 ms
Total Talk Time (AGENT): 93932 ms
Total Talk Time (CUSTOMER): 114000 ms
Interruptions: 0
Overall Sentiment: AGENT=2.4, CUSTOMER=1.1
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/04/10/24673875-2440-473a-a9cb-d84472ffe3a6_20250410T21:07_UTC.wav
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[AGENT][POSITIVE] Good afternoon. Thank you for calling APL. My name is [PII]. How may I help you?
[CUSTOMER][NEUTRAL] Hi [PII], how are you? I'm [PII] calling from the Florida Center for allergy and asthma Care. I was just hoping to do some eligibility and benefits for a patient of ours.
[AGENT][POSITIVE] OK. Well, I'll be more than happy to help you with the eligibility and benefits. And well, may I have a good contact number in case we're disconnected and the policy number?
[CUSTOMER][NEUTRAL] Sure, [PII].
[AGENT][POSITIVE] Thank you for that. And may I have the
[CUSTOMER][NEUTRAL] And the plan number for the member.
[AGENT][POSITIVE] Oh, I'm sorry.
[CUSTOMER][NEUTRAL] Yes, it's 025.
[CUSTOMER][NEUTRAL] 80,020.
[AGENT][NEUTRAL] Thank you, hold on one moment.
[CUSTOMER][NEUTRAL] 99214.
[CUSTOMER][NEUTRAL] 951-15.
[AGENT][NEUTRAL] And can you verify the member's first and last name and date of birth?
[CUSTOMER][NEUTRAL] Sure, it's gonna be [PII]. Date of birth [PII].
[AGENT][NEUTRAL] Thank you for that and all the information provided is a verification of benefits, not a guarantee of payment, and I am showing the policy is active. It's been effective since [PII].
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] And what type of benefits did you want to go over today?
[CUSTOMER][NEUTRAL] Um, well, I wanted to start off by asking what type of plan it was HMO, EPO, PPO, POS and um see if there was a co-payment for office visits or allergy services.
[AGENT][NEUTRAL] OK, so it's not, it's none of those networks. This is a secondary policy. So we're second to the Florida Blue plan. We pay towards the copay, deductible and co-insurance of covered charges after primary. Are you all considered outpatient?
[CUSTOMER][NEUTRAL] So
[CUSTOMER][NEUTRAL] Yes.
[AGENT][NEUTRAL] OK, let's see.
[AGENT][NEUTRAL] For outpatient, we would pay up to $500 per calendar day.
[CUSTOMER][NEUTRAL] Yeah
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] So each day they have $500 to use towards their outpatient expenses.
[CUSTOMER][NEUTRAL] OK, let me see.
[CUSTOMER][NEUTRAL] And then is it a total out of pocket expense? It's a 500, right?
[AGENT][NEUTRAL] No, that's more so for primary. Yeah, the 500 isn't out of pocket though, that's just their max for expenses.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] But
[CUSTOMER][NEUTRAL] Right, OK, let me just go ahead with this, so everything would be covered for whatever um is not covered by the primary, right?
[AGENT][NEUTRAL] No, only the co-pay, deductible and co-insurance is what our policy pays towards, up to $500 per calendar day.
[CUSTOMER][NEUTRAL] Mm.
[CUSTOMER][NEUTRAL] OK, got it.
[CUSTOMER][POSITIVE] You got it, got it.
[CUSTOMER][NEUTRAL] All right.
[CUSTOMER][NEUTRAL] Question, um, is there a reference number you can provide me with?
[AGENT][NEUTRAL] Mhm.
[AGENT][NEUTRAL] So there's no call reference number, but you can use my name in today's date and again that's [PII] to my [PII] is [PII].
[CUSTOMER][NEUTRAL] OK, and then today's date, right?
[AGENT][NEUTRAL] Mhm.
[AGENT][NEUTRAL] Uh
[CUSTOMER][POSITIVE] Alright, yeah, I think I got everything I needed.
[CUSTOMER][POSITIVE] All right, um thank you so much for your time and your help I appreciate it.
[AGENT][POSITIVE] You're welcome. Well, thanks for calling APL and I hope you have a great day.
[CUSTOMER][POSITIVE] Thank you have a good one.
[AGENT][POSITIVE] Thank you you too. Bye-bye.
[CUSTOMER][NEUTRAL] Bye bye.