AccountId: 011433970860
ContactId: 2584b3bb-0a24-4286-afc8-7adb9c9e55ff
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 262029 ms
Total Talk Time (AGENT): 128241 ms
Total Talk Time (CUSTOMER): 132194 ms
Interruptions: 3
Overall Sentiment: AGENT=1.2, CUSTOMER=0.7
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/03/04/2584b3bb-0a24-4286-afc8-7adb9c9e55ff_20250304T16:10_UTC.wav
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[AGENT][NEUTRAL] Thank you for calling APL. This is [PII]. How can I help you?
[CUSTOMER][NEUTRAL] Hi, [PII]. Um, my name is [PII], and I need to get uh uh what these benefits are for one of my patients who was having surgery.
[AGENT][POSITIVE] Sure, I could check benefits for you. Uh, [PII], can I get a good call back number from you first in case we're disconnected?
[CUSTOMER][NEUTRAL] Sure.
[CUSTOMER][NEUTRAL] Yes, it's uh [PII].
[AGENT][NEUTRAL] Thank you. And then do you have the policy number?
[CUSTOMER][NEUTRAL] Yes, now there's two numbers, uh, one of them ends in an 8 and one of them ends in a 7, it's 02 02444949 ML 847.
[AGENT][POSITIVE] Either one is perfectly fine. Uh-huh.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] And then uh what was the name and date of birth for the insured please?
[CUSTOMER][NEUTRAL] [PII], date of birth [PII].
[AGENT][NEUTRAL] Perfect, thank you for verifying that [PII]. Uh, so this policy is active. Effective date was [PII], and this is a secondary medical policy, so it is designed to help with co-pay, deductible and co-insurance after major medical pays. Um, we were needing to look at the outpatient benefits, is that right?
[CUSTOMER][NEUTRAL] Um, so, well, I'm not sure. Let me explain. We are the, um, physician and we will be doing an outpatient surgery.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] Uh-huh.
[AGENT][NEUTRAL] Sure, OK, yeah, so the benefits are split between uh inpatient and outpatient, so there's a specific um benefit amount for each so and of course I will let you know verification of coverage is not a guarantee of payment for claims. The outpatient benefit is on a per calendar day basis, so it would pay up to a maximum of $1000 per calendar day.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK. And does it pay for the physician services?
[AGENT][NEUTRAL] It all goes towards uh co-pay, deductible and coinsurance. So as long as uh their major medical, uh, is willing to pay this policy can. If their major medical does not pay, this policy can't.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK. Now, if, so, um, so we're the physician, there's also obviously a, a facility where we'll be doing the surgery. Is that a separate benefit for the patient?
[AGENT][NEUTRAL] Mhm.
[AGENT][NEUTRAL] Sure.
[AGENT][NEUTRAL] No, as long as that's um it's all going to be outpatient, so that would all fall fall under that category.
[CUSTOMER][NEUTRAL] OK, so the $1000 is split between all the people that provide services that day.
[AGENT][POSITIVE] Correct, yes.
[CUSTOMER][NEUTRAL] Or the first one whose claim gets processed.
[AGENT][POSITIVE] That's correct, up to that $1000 limit, yes ma'am.
[CUSTOMER][NEUTRAL] Yes.
[CUSTOMER][NEUTRAL] OK, all right, so it is good for the physician for outpatient services. Is this something that also is, um, would pay the patient's um deductible or co-pay for just a regular office visit?
[AGENT][NEUTRAL] Mhm.
[AGENT][NEUTRAL] Um, so let's see, for this policy, office visits themselves are not covered. Uh, however, treatment received in office is.
[AGENT][NEUTRAL] So if it were simply like a consultation.
[CUSTOMER][NEUTRAL] So patients, she pays her $85 co-pay, but we do X-rays.
[AGENT][NEUTRAL] I'm sorry.
[AGENT][NEUTRAL] OK, yeah, so that would be considered treatment in office, right.
[CUSTOMER][NEUTRAL] And it, it would cover the X-ray?
[CUSTOMER][NEUTRAL] Ah, OK.
[CUSTOMER][NEUTRAL] X
[CUSTOMER][NEUTRAL] OK, and for us being the doctor we would use the number that ends with an 8.
[AGENT][NEUTRAL] Mhm.
[AGENT][NEUTRAL] Yes, for that's the outpatient.
[CUSTOMER][NEUTRAL] OK, alright, and let's see.
[CUSTOMER][NEUTRAL] You said it was effective [PII]. What what when mhm sorry, give me that effective date again please.
[AGENT][NEUTRAL] That's OK.
[AGENT][NEUTRAL] Yes, that was uh [PII].
[CUSTOMER][NEUTRAL] And paid current.
[AGENT][POSITIVE] Correct.
[CUSTOMER][POSITIVE] OK, that is perfect, very good information. Can I get a reference number?
[AGENT][NEUTRAL] Sure, that would just be my first name, last initial and today's date. Uh so my name is spelled [PII] Was there anything else I can help you with [PII]?
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][POSITIVE] That's it. Thanks so much, [PII]. I do appreciate you. Mhm.
[AGENT][POSITIVE] Alright, of course, thanks for calling APL I you have a great rest of your day.
[CUSTOMER][POSITIVE] Thank you. Bye-bye.
[AGENT][NEUTRAL] Bye bye.