AccountId: 011433970860
ContactId: 2f736e4b-bca9-43f4-90fb-903ed01978cc
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 283149 ms
Total Talk Time (AGENT): 144986 ms
Total Talk Time (CUSTOMER): 78613 ms
Interruptions: 0
Overall Sentiment: AGENT=1.4, CUSTOMER=1
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/03/18/2f736e4b-bca9-43f4-90fb-903ed01978cc_20250318T18:03_UTC.wav
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[AGENT][NEUTRAL] Calling American Public Life. This is [PII]. How can I help you?
[CUSTOMER][NEUTRAL] Hello, [PII]. Uh, my name is [PII]. I am a part of
[CUSTOMER][NEUTRAL] Um, I, I have a plan through American Public Life, and I just want to get a quote on how much it will cost to go to see a specific doctor.
[AGENT][NEUTRAL] OK, let me take a look at your policy. Can I get uh your policy number?
[CUSTOMER][NEUTRAL] My policy number is 02597230.
[AGENT][NEUTRAL] And [PII], if you could verify your date of birth.
[CUSTOMER][NEUTRAL] [PII].
[AGENT][POSITIVE] OK, thank you. And if I could get a callback number for for you really quick.
[CUSTOMER][NEUTRAL] Um, this number is [PII].
[CUSTOMER][NEUTRAL] [PII]
[CUSTOMER][NEUTRAL] [PII] just leave a voicemail and then best way to reach you.
[AGENT][POSITIVE] Thank you.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] And you're calling to see uh what your cost would be for a physician visit?
[CUSTOMER][NEUTRAL] Um, to see, like, uh, I wanted to see a, um, sports scientist doctor.
[CUSTOMER][NEUTRAL] And I just wanna know what like what kind of benefits.
[CUSTOMER][NEUTRAL] Is provided.
[AGENT][NEUTRAL] What type of provider?
[CUSTOMER][NEUTRAL] A sports sports, uh, medicine.
[AGENT][NEUTRAL] OK, OK, please be advised verifying benefits does not guarantee payment. I show, uh, your policy does cover benefits for physician office visit. You are allowed I'm sorry, 4 visits a year, and the policy will pay $50 per visit.
[CUSTOMER][NEUTRAL] Um,
[CUSTOMER][NEUTRAL] It's not the MEC, right? This is the medical?
[AGENT][NEUTRAL] This is the medical, yes.
[CUSTOMER][NEUTRAL] It's only 50.
[AGENT][NEUTRAL] Yes, and that's for any uh type of physician.
[AGENT][NEUTRAL] This is a limited medical plan, so it pays um a base amount or, you know, your max, it's, it's just a set amount for the visit and for a physician visit, your um maximum amount that it will pay is $50 a visit.
[CUSTOMER][NEUTRAL] Do you
[CUSTOMER][NEUTRAL] So, so it's, it's like agree rate and then minus 50.
[CUSTOMER][NEUTRAL] Is that what I'm hearing?
[AGENT][NEUTRAL] We, your, your policy will pay 50.
[CUSTOMER][NEUTRAL] Mm.
[AGENT][NEUTRAL] So I'm not sure what the doctor will actually bill you, but your policy will only pay 50. And if there is a balance, um, if there, if there's a difference, it will be left up to your provider how uh they settle that.
[CUSTOMER][NEUTRAL] And do you know, do you know our provider, is it, is it um multi plan?
[AGENT][NEUTRAL] Uh, now they can go through multiplan to get a discount for you, but as far as a list of providers, uh, there would not be a list of providers because this is a non-contracted policy. You are able to go to any provider as long as they accept it, um, and the benefit will pay the same.
[CUSTOMER][POSITIVE] OK, it's very interesting. I'm trying to understand, OK.
[CUSTOMER][NEUTRAL] Network
[CUSTOMER][NEUTRAL] It could be because I because my network is through a multi-plan, so I'm like, so if I have agreed a contract rate with multi plan and then I pay, you pay $50 and I pay the rest. I is that how?
[CUSTOMER][NEUTRAL] Like it's
[AGENT][NEUTRAL] As far as what you will pay as the $50 that will be left up to the provider.
[CUSTOMER][NEUTRAL] I
[AGENT][NEUTRAL] The provider could write off the balance, you know, that is left up to the provider. You would have to, uh, you know,
[AGENT][NEUTRAL] That would be up to your provider. We would not determine patient responsibility. We would only pay the $50 and then after that, any balance, any leftover amount is left over to them. That's how the um that's it's left up to the provider on how they want to settle it as far as if they would collect the difference or write it off.
[CUSTOMER][POSITIVE] Got it got it OK.
[CUSTOMER][POSITIVE] Oh, OK, thank you so much.
[AGENT][POSITIVE] You're welcome. Is there anything else I can help you with?
[CUSTOMER][NEUTRAL] Um,
[CUSTOMER][POSITIVE] Um, not, not right now, but thank you, thank you, thank you so much.
[AGENT][POSITIVE] You're welcome. Have a wonderful day, [PII]. Thank you for calling APL. Bye-bye.
[CUSTOMER][NEUTRAL] Right.
[CUSTOMER][POSITIVE] No problem bye bye.