AccountId: 011433970860
ContactId: 296d5cca-e2f0-46aa-9d79-8df1ad5f8e02
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 420489 ms
Total Talk Time (AGENT): 194401 ms
Total Talk Time (CUSTOMER): 78567 ms
Interruptions: 1
Overall Sentiment: AGENT=1.2, CUSTOMER=0.9
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/01/10/296d5cca-e2f0-46aa-9d79-8df1ad5f8e02_20250110T14:58_UTC.wav
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[AGENT][POSITIVE] Good morning. Thank you for calling APL. This is [PII]. How can I help you?
[CUSTOMER][NEUTRAL] Hi [PII], I'm calling to find out if this member's um policy covers their office visit copay?
[AGENT][NEUTRAL] OK, so you're needing to verify if the benefits on this, this member's plan with APL covers office benefits, is that correct?
[CUSTOMER][NEUTRAL] Yeah, yes, because.
[AGENT][POSITIVE] Yes, ma'am, I can help you with that. And who am I, oh, I'm so sorry, go ahead.
[CUSTOMER][NEUTRAL] No, no, no, go ahead. My name is [PII].
[AGENT][POSITIVE] Thank you. And [PII], your callback number?
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] Thank you and the member's policy number please, [PII].
[CUSTOMER][NEUTRAL] 02432985
[AGENT][POSITIVE] Thank you one moment.
[AGENT][NEUTRAL] And what any information, [PII] that I do provide for you today will be a verification of benefits and not a guarantee of payment. What is your patient's name, please, and their date of birth?
[CUSTOMER][NEUTRAL] [PII] and the date of birth is [PII].
[CUSTOMER][NEUTRAL] Oh my gosh, I'm getting so old. [PII] is a [PII].
[AGENT][NEUTRAL] Right.
[CUSTOMER][NEUTRAL] Oh my my lord.
[AGENT][NEUTRAL] Right, I know, I.
[CUSTOMER][NEGATIVE] Some of these dates of birth I'm like wow jeez.
[AGENT][NEUTRAL] Uh
[AGENT][NEUTRAL] Yeah, you look at the date of birth, it's not so like life-changing. You look at the age, you know, you put that age number and they're like, wow, yeah. Mhm. Trust me. I understand.
[CUSTOMER][POSITIVE] And you're like, whoa.
[CUSTOMER][NEUTRAL] Yeah
[CUSTOMER][POSITIVE] Oh how funny.
[AGENT][NEUTRAL] OK, so just one moment please.
[AGENT][NEUTRAL] OK, so I do show that she is a dependent on this plan. This policy, this supplemental policy is active, effective [PII].
[AGENT][NEUTRAL] And give me just a moment to get her benefit information pulled up.
[AGENT][NEUTRAL] Alright, give me just an additional moment.
[CUSTOMER][POSITIVE] No, no. Take your time. You're fine.
[AGENT][POSITIVE] Thank you so much.
[AGENT][POSITIVE] Thank you for your patience.
[CUSTOMER][NEUTRAL] No, you're fine.
[AGENT][NEUTRAL] I don't believe that it does, but I want to check one more thing as far as the office visit portion. Um, I don't believe that it does, but I'm just double, double checking.
[CUSTOMER][NEUTRAL] Yeah, I
[CUSTOMER][NEUTRAL] I know it's it's only 1 out of 10 that does. And the reason why I'm calling in particular is because my best friend, she works for the fire department and her American public covers the office visit copay, but it's
[AGENT][NEUTRAL] Yeah, they're
[AGENT][NEUTRAL] Mhm.
[AGENT][NEUTRAL] Yes, some of the plans, yes, some of the plans do, um, cover the office visits.
[CUSTOMER][NEUTRAL] But they're extra.
[AGENT][NEUTRAL] Yeah, there are different, yeah, right. Um, it just, it's
[CUSTOMER][NEUTRAL] I know not everybody has it.
[CUSTOMER][POSITIVE] So I like to call just so that they feel like we're, we're checking for them.
[AGENT][NEUTRAL] Oh,
[AGENT][NEUTRAL] Oh, absolutely, because it just depends on the benefit plan option that the employer goes with, you know, when they're
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] Um, when they make that determination, so yes, some of them cover office visits, you know, some of them are per calendar day benefits versus per calendar year benefits. So some of them are per occurrence. So yeah, it always call to, to verify, um, on this policy though.
[AGENT][NEGATIVE] Office visits are not covered.
[CUSTOMER][NEUTRAL] OK. And can I get your name?
[AGENT][NEUTRAL] Yes, ma'am. It is [PII]
[AGENT][NEUTRAL] And the first initial to my last name is [PII].
[CUSTOMER][NEUTRAL] Mm.
[CUSTOMER][NEUTRAL] OK, and do you have a reference number?
[AGENT][NEUTRAL] And you would use my name. It would be my name along with today's date, [PII], and then should you all end up filing a claim with us, and you may already be aware of these next two things I'm going to tell you, but when on these meddling policies when the claim is filed with APO, we always have to have a copy of their primary insurance company's explanation of benefits as well.
[AGENT][NEUTRAL] And then we do have a portal in which our claim status can be checked and have access to our explanation of benefits by going to [PII].
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][POSITIVE] OK perfect thank you so much I appreciate your help, [PII] and I hope you have a beautiful weekend.
[AGENT][POSITIVE] Well, you are, I hope you do too, [PII], and thank you again for calling APL.
[CUSTOMER][NEUTRAL] Alright bye bye.
[AGENT][NEUTRAL] Um, bye bye.