AccountId: 011433970860
ContactId: 248fe2d5-d14e-4c5e-8dd3-a28b35202644
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 192220 ms
Total Talk Time (AGENT): 104862 ms
Total Talk Time (CUSTOMER): 80906 ms
Interruptions: 0
Overall Sentiment: AGENT=1.8, CUSTOMER=1
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/05/21/248fe2d5-d14e-4c5e-8dd3-a28b35202644_20250521T16:04_UTC.wav
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[AGENT][POSITIVE] Good morning. Thank you for calling APL. My name is [PII]. How may I help you?
[CUSTOMER][NEUTRAL] Hi [PII], good morning. My name is [PII]. I'm calling from Vital MD Group Holdings, and I'm calling to get benefits and eligibility for a member, please.
[AGENT][POSITIVE] OK, well, I'll be more than happy to help you with the eligibility and benefits. And [PII], may I have a good contact, you're you're welcome. May I have a good contact number in case we're disconnected and the policy number?
[CUSTOMER][POSITIVE] Thanks.
[CUSTOMER][NEUTRAL] Yes, um, telephone number is [PII], and that's correct, and policy number is 02473494M as in Mary, L as in Lima, and 8 and the number 8.
[AGENT][NEUTRAL] Thank you, hold on one moment.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] And can you verify the member's first and last name and date of birth?
[CUSTOMER][NEUTRAL] Yeah, [PII], date of birth is [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]. And what type of benefits did you want to go over today?
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Um, so I'm calling from an OBGYN office and I needed to get benefits. I know it's a gap insurance, so I needed to know what the coverage would be up to what amount for well woman an office visit, office procedures, and ultrasounds, please.
[AGENT][NEUTRAL] Mhm.
[AGENT][NEUTRAL] Alright, so we pay towards the copay, deductible and co-insurance of coverage charges after primary up to $1500 per calendar day for this policy. So it's $1500 each day to use.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Per calendar today.
[AGENT][NEUTRAL] Um, so there's no coverage for like the office setting itself for this policy, but she does have the office treatment rider. So any treatment done in the office as long as it's not cosmetic could be covered up to that 1500 per day.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK, so like an office visit itself is not covered, but anything like diagnostic.
[CUSTOMER][NEUTRAL] Is that correct?
[AGENT][NEUTRAL] Mhm. So if you all charge a facility charge like 99213, 99214, that will most likely be denied because that's a place of service. But if you bill us for, I don't know, I don't know, some type of treatment that's done in the office, then that would be the treatment writer and it would, it could cover as long as it's not cosmetic.
[CUSTOMER][NEUTRAL] Uh-huh.
[CUSTOMER][NEUTRAL] Uh-huh.
[CUSTOMER][NEUTRAL] OK, alright, and then you said it's 1500 per day per calendar day and is that the same benefit for an inpatient as well?
[AGENT][NEUTRAL] Mhm.
[AGENT][NEUTRAL] Uh let me see, hold on one second.
[AGENT][NEUTRAL] Inpatient is 2000 up to $2000 per consignment.
[CUSTOMER][NEUTRAL] For confinement. OK, alright, perfect. And then is there a reference number please?
[AGENT][NEUTRAL] So there's no call reference number, but you can use my name and today's date, and again, that's [PII], first initial of my last name is [PII].
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][POSITIVE] Perfect. Thank you so much. I appreciate your help.
[AGENT][POSITIVE] You're welcome, [PII], and thanks for calling APL. I hope you have a great day.
[CUSTOMER][POSITIVE] You too. Thanks. Bye bye.
[AGENT][POSITIVE] Thank you. Bye-bye.