AccountId: 011433970860
ContactId: 2c24fc5f-cd9f-4f65-9c37-38a9136759d8
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 271179 ms
Total Talk Time (AGENT): 104059 ms
Total Talk Time (CUSTOMER): 107298 ms
Interruptions: 1
Overall Sentiment: AGENT=1, CUSTOMER=0.6
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/01/22/2c24fc5f-cd9f-4f65-9c37-38a9136759d8_20250122T18:13_UTC.wav
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[AGENT][NEUTRAL] Thank you for calling APL. This is [PII]. How can I help you?
[CUSTOMER][NEUTRAL] Hi, I'm calling to verify benefits, um, and eligibility on a patient.
[AGENT][NEUTRAL] Yeah, I get that uh check benefits and eligibility for you. Uh, what was your name?
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] My name is [PII].
[AGENT][NEUTRAL] Alright [PII], can I get a good call back number from you in case we're disconnected?
[CUSTOMER][NEUTRAL] Sure it's [PII].
[AGENT][NEUTRAL] All right, thank you. And then do you have the policy number?
[CUSTOMER][NEUTRAL] Uh yeah, it's 02559258.
[AGENT][POSITIVE] All right, thank you.
[AGENT][NEUTRAL] And uh what was the name and date of birth for the insured?
[CUSTOMER][NEUTRAL] Uh, it's [PII]. Date of birth is [PII].
[AGENT][NEUTRAL] Alright, 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. and we're reading to look at was the outpatient benefits.
[CUSTOMER][NEUTRAL] Um, well, she is coming in for an office visit, um, so I actually don't know if it covers the copay or if it covers deductible for tomorrow's visit.
[AGENT][NEUTRAL] OK, yeah, let me see if office visits are covered under this policy. Um, will she be receiving treatment or is this gonna be more of a consultation?
[CUSTOMER][NEUTRAL] Uh, she is following up after surgery, so it's like a post-op visit.
[AGENT][NEUTRAL] OK, OK, no worries, one moment, and this was an actual physician's office, correct?
[CUSTOMER][NEUTRAL] Yes, specialist office.
[AGENT][POSITIVE] Special OK thank you one moment.
[CUSTOMER][POSITIVE] Thank you.
[CUSTOMER][NEUTRAL] Thought that was your name?
[CUSTOMER][NEUTRAL] So when you get a chance when you call or let me know.
[CUSTOMER][NEUTRAL] Oh my God.
[CUSTOMER][NEUTRAL] I just wanted to confirm that that was the [PII] male.
[CUSTOMER][NEUTRAL] Oh my god
[CUSTOMER][NEUTRAL] Oh my God.
[CUSTOMER][NEUTRAL] I don't know.
[AGENT][POSITIVE] Bear with me just a moment. I appreciate your patience.
[CUSTOMER][POSITIVE] OK, thank you.
[CUSTOMER][NEUTRAL] But I, I'm like.
[CUSTOMER][POSITIVE] I wanted to laugh so bad.
[AGENT][NEUTRAL] OK, of course, I will let you know verification of coverage is not a guarantee of payment for claims. uh, so for this policy, office visits are not going to be covered.
[CUSTOMER][NEUTRAL] No
[CUSTOMER][NEGATIVE] Like screaming and crying
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] So it doesn't cover the visit co-pay, does it cover deductibles?
[AGENT][POSITIVE] Correct.
[AGENT][NEGATIVE] Um, it would not be able to pay for anything regarding an office visit.
[CUSTOMER][NEUTRAL] OK, so, so this plan does not cover deductibles either, like if they have an X-ray or an injection.
[AGENT][NEUTRAL] No treatment in office uh would be considered, um, would be covered. It's just the visit itself would not be.
[CUSTOMER][NEUTRAL] OK, so, OK.
[CUSTOMER][NEUTRAL] So X-rays, injections.
[AGENT][NEUTRAL] That's their outpatient benefit is $500 per calendar day.
[CUSTOMER][NEUTRAL] like it was like oh my.
[CUSTOMER][NEUTRAL] Wait, so
[CUSTOMER][NEUTRAL] Outpatient, like, I'm sorry, outpatient like if they go to the hospital?
[AGENT][NEUTRAL] No, um, it would uh office treatment would fall under their outpatient benefit.
[CUSTOMER][NEUTRAL] Oh OK.
[CUSTOMER][NEUTRAL] So it has a $500 deductible you said?
[AGENT][NEUTRAL] No, that's the maximum benefit amount we would pay. There is no deductible.
[CUSTOMER][NEUTRAL] OK
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] And what is your name?
[AGENT][NEUTRAL] It's [PII]
[AGENT][NEUTRAL] Was there anything else I could help you with, [PII]?
[CUSTOMER][NEUTRAL] And
[CUSTOMER][NEUTRAL] No, is there a reference number for the call?
[AGENT][NEUTRAL] It would just be my first name, last initial, and today's date, uh, so my last initial is A.
[CUSTOMER][NEUTRAL] What's
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][POSITIVE] All right thank you very much.
[AGENT][POSITIVE] Alright, yeah, thanks for calling APL. I hope you have a great rest of your day.
[CUSTOMER][POSITIVE] OK you too thanks bye.
[AGENT][NEUTRAL] Bye bye.