AccountId: 011433970860
ContactId: 2e44213c-c6af-4bc5-be73-314fd9c4e367
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 472320 ms
Total Talk Time (AGENT): 207885 ms
Total Talk Time (CUSTOMER): 158403 ms
Interruptions: 1
Overall Sentiment: AGENT=0.5, CUSTOMER=0.4
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/04/02/2e44213c-c6af-4bc5-be73-314fd9c4e367_20250402T18:28_UTC.wav
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[AGENT][NEUTRAL] Good afternoon. Thank you for calling APL. This is [PII]. How may I assist you?
[CUSTOMER][NEUTRAL] Hi, I'm calling from Cook's Pediatrics Doctor Wheeler's office. I needed to verify benefits. May you repeat your name, please?
[AGENT][NEUTRAL] Sure. My name is So. That's [PII].
[CUSTOMER][POSITIVE] OK, got it, thank you, Miss [PII].
[AGENT][NEUTRAL] OK. May I have your name? You're welcome.
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] OK, Ms. [PII], may I have a callback number just in case we get disconnected?
[CUSTOMER][NEUTRAL] [PII] no extension.
[AGENT][NEUTRAL] Thank you. And may I have the patient's policy number?
[CUSTOMER][NEUTRAL] 02586771
[AGENT][POSITIVE] All right, thank you.
[CUSTOMER][NEUTRAL] Yeah.
[AGENT][NEUTRAL] Yes.
[AGENT][NEUTRAL] One
[AGENT][NEUTRAL] OK, what's the name and date of birth of the patient?
[CUSTOMER][NEUTRAL] Uh, for any.
[CUSTOMER][NEUTRAL] OK, um, well, the baby is still in the still in the process of adding, so it's gonna be under mom.
[CUSTOMER][NEUTRAL] This is my chart
[AGENT][NEUTRAL] What's the name and date of birth of the mom?
[CUSTOMER][NEUTRAL] [PII]
[CUSTOMER][NEUTRAL] [PII].
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] OK, um let me see.
[AGENT][NEUTRAL] And what is, when was the baby born?
[CUSTOMER][NEUTRAL] What is your name?
[CUSTOMER][NEUTRAL] [PII] of this year.
[AGENT][NEUTRAL] OK, so this recent OK.
[AGENT][NEUTRAL] Um, alright, and let me see.
[CUSTOMER][NEUTRAL] I'm just verify that you are authorizing.
[AGENT][NEUTRAL] So this is like a routine office visit or what type of service is being render?
[CUSTOMER][NEUTRAL] The
[CUSTOMER][NEUTRAL] Yes, yes, ma'am.
[CUSTOMER][NEUTRAL] Um, well, um, I need to just the general, uh, benefits for office visit and then the routine well, uh, baby and immunization coverage please.
[AGENT][NEUTRAL] OK, Miss [PII], um,
[AGENT][NEUTRAL] OK. Let me let you know that this is a secondary supplemental plan to the major medical. OK, so, um, wellness is not covered under this plan, OK? This is only for sickness.
[CUSTOMER][NEUTRAL] OK
[CUSTOMER][NEUTRAL] OK, so for the sickness.
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] And is there like a copay?
[AGENT][NEUTRAL] Yes, um, not with us because we're just the secondary.
[AGENT][NEUTRAL] And let me go ahead and give you the benefits I got here for this number and this is not a guarantee of payment, just a verification of coverage and that's just a disclaimer.
[AGENT][NEUTRAL] So this one has a, let's see.
[AGENT][NEUTRAL] An inpatient and outpatient combined maximum.
[AGENT][NEUTRAL] Of 2100 per covered person per calendar year.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] And see, so this one includes office treatments.
[CUSTOMER][NEUTRAL] think
[AGENT][NEUTRAL] And let me see if it includes the office visit, bear with me.
[AGENT][NEUTRAL] Mm
[AGENT][NEUTRAL] Let me double check.
[AGENT][NEUTRAL] Bear with me. And the baby's only gonna be covered the 1st 30 days of life unless he's added to the policy, OK?
[AGENT][NEUTRAL] Um
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] OK, bear with me.
[CUSTOMER][NEUTRAL] You said she
[AGENT][NEUTRAL] I'm waiting on the full breakdown of benefits. It didn't show if he has an office visit benefit. He only has the office treatment so far. That's all I see. Um, let me see.
[CUSTOMER][NEUTRAL] There
[AGENT][NEUTRAL] OK, so this one it looks like it only covers the office procedures. It doesn't cover the co-payment for the visit. It's just gonna be office procedures, and this is for sickness or accidents only.
[CUSTOMER][NEUTRAL] B.
[CUSTOMER][NEUTRAL] 17
[AGENT][NEUTRAL] No preventative or wellness. Mhm, yes.
[CUSTOMER][NEUTRAL] Sickness accident?
[CUSTOMER][NEUTRAL] So no immunization, no wellness coverage, correct?
[AGENT][NEUTRAL] No.
[AGENT][NEUTRAL] No preventative, no wellness.
[CUSTOMER][NEUTRAL] And no copay?
[AGENT][NEUTRAL] No.
[CUSTOMER][NEUTRAL] No co-pay and then you all covered uh 2100 per person per calendar year, is that, is that correct?
[AGENT][POSITIVE] Correct. And that is a combined outpatient and inpatient benefit.
[CUSTOMER][NEUTRAL] OK, so if let's say if we send a patient for X-ray.
[CUSTOMER][NEUTRAL] So that's included?
[AGENT][NEUTRAL] Yes, if you have to do an X-ray due to a sickness or an accident, then it could be um covered under that office treatment rider.
[AGENT][NEUTRAL] And then we, what we do is we help with the co-payments, co-insurance and deductibles from the major medical. The only thing we do not cover is the co-payment for the office visit. And um let's see, um, Ms. [PII], I also see that there is a deductible on this one. This one does have a $1000 deductible before we pay out of that maximum benefit.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Are
[CUSTOMER][NEUTRAL] OK, you said 1000, is that per person or per family?
[AGENT][NEUTRAL] Per person. Yes, it's gonna be per person per calendar year.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] So, um, let's say if the baby is not gonna be add on this.
[CUSTOMER][NEUTRAL] Insurance, will you still cover the 1st 3030 days?
[AGENT][NEUTRAL] Correct. The baby is covered for the 1st 30 days of life. After that, if he's not added, then he's gonna be um lapsed, OK?
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Check one for you ma'am which patient are you calling um the only thing I have with the 4th that last.
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] OK, so let, uh, if the baby comes in for the first.
[CUSTOMER][NEGATIVE] Like the 1st 2 weeks checkup for newborn checkup, that's not covered.
[AGENT][NEUTRAL] No.
[CUSTOMER][NEUTRAL] No.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] And that's all I need and if I can get a reference.
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Call number please.
[AGENT][NEUTRAL] We don't have reference numbers. You can use my name and today's date if you will.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][POSITIVE] Thank you, Miss [PII].
[AGENT][NEUTRAL] You're welcome. Is there anything else I may help you with today, Ms. [PII]?
[CUSTOMER][POSITIVE] Uh, no, that's it, thank you.
[AGENT][POSITIVE] OK. You're welcome. Thank you for calling APO. Have a good day.
[CUSTOMER][NEUTRAL] Have.
[CUSTOMER][POSITIVE] You too thank you bye bye.
[AGENT][POSITIVE] Thank you. Bye bye.