AccountId: 011433970860
ContactId: 3007a4f2-3fc1-41d4-846b-261328148899
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 232199 ms
Total Talk Time (AGENT): 120752 ms
Total Talk Time (CUSTOMER): 94997 ms
Interruptions: 0
Overall Sentiment: AGENT=0.5, CUSTOMER=0
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/03/11/3007a4f2-3fc1-41d4-846b-261328148899_20250311T19:26_UTC.wav
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[CUSTOMER][NEUTRAL] Hello?
[CUSTOMER][NEUTRAL] OK
[CUSTOMER][NEUTRAL] Oh.
[AGENT][POSITIVE] Thank you for calling American Public Life. This is [PII]. How can I help you?
[CUSTOMER][NEUTRAL] Mm
[CUSTOMER][NEUTRAL] Hi, [PII]. This is [PII]. I'm calling to get benefits for a patient, um, and I'm not sure if this is just a dental plan or if it's a medical plan. Um, so I'm just calling to get verification. Sure.
[AGENT][NEUTRAL] OK, I can take a look at it.
[AGENT][NEUTRAL] OK. And what is the policy number you're calling on?
[CUSTOMER][NEUTRAL] It is 023-273-86.
[AGENT][NEUTRAL] The patient's name and date of birth?
[CUSTOMER][NEUTRAL] Patient's name is [PII] and her date of birth is [PII].
[AGENT][POSITIVE] OK, thank you so much for verifying the account and you did say benefits. You are calling for dental benefits.
[CUSTOMER][NEUTRAL] Uh-huh.
[CUSTOMER][NEUTRAL] No, um, vision, I care.
[AGENT][NEUTRAL] OK. OK. So this policy would not cover their vision. I'm not sure who the administrator is for their vision coverage.
[AGENT][NEGATIVE] Uh, it looks like, uh, they only have a, looks like a dental and a medical policy with us, but this would not be covered.
[CUSTOMER][NEUTRAL] OK, what's her, what's the medical policy for um this patient?
[AGENT][NEUTRAL] The policy number or what?
[CUSTOMER][NEUTRAL] What the uh who is the is it the that I just read to you?
[AGENT][NEUTRAL] American Public Life is the medical.
[CUSTOMER][NEUTRAL] American Public Life is her medical insurance. Is she here, she's here for a medical, isn't she? Yes, she's here for a vision, medical vision exam.
[AGENT][NEUTRAL] Yes, ma'am.
[AGENT][NEUTRAL] OK. Please be advised verifying benefits is not guaranteed payment.
[CUSTOMER][NEUTRAL] So,
[AGENT][NEUTRAL] OK, let me take a look at our benefits.
[CUSTOMER][NEUTRAL] Oh
[AGENT][NEUTRAL] OK, for.
[AGENT][NEUTRAL] A physician visit, it looks like the policy will pay $50 a visit. The patient has 4 visits a year to use.
[AGENT][NEUTRAL] Is there anything else I can help you with?
[CUSTOMER][NEUTRAL] Um, so, uh, well, yeah, I need to know, so the, the policy pays for $50 of a visit for a medical eye visit.
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] And does the patient pay the difference? I don't understand what.
[AGENT][NEUTRAL] Uh, we didn't, OK, this is a limited medical plan, so it pays up to a, uh, like a max amount for a physician visit, physician sick visit. Uh, the policy pays $50 a visit. She has $4 to use as far as patient responsibility after whatever is left after $50. We do not determine patient responsibility, we will just pay the $50 that the um patient responsibility is left to the provider.
[CUSTOMER][NEGATIVE] How am I supposed to know what to collect and what not to collect?
[CUSTOMER][NEUTRAL] All of our other insurance companies tell us, hey, we pay 50%, the patient pays the difference minus whatever.
[AGENT][NEUTRAL] OK, well, this is not a percentage, it is a dollar amount. We pay $50 of her visit.
[CUSTOMER][NEUTRAL] Sure, I, I get it that you pay $50. I completely understand that. What I don't understand is what I can charge the patient. Can I charge the patient the difference of the fee? Cause the exam fee is not $50.
[AGENT][NEUTRAL] That is left
[AGENT][NEUTRAL] Exactly, I understand that. Again, that is left up to the provider. Uh, you can uh contact Multiplan for this uh policy for a discount.
[AGENT][NEUTRAL] But as far as like when we process the claim and send out the explanation of benefits to you, it just will show the $50 payment.
[CUSTOMER][POSITIVE] OK. All right. Thank you very much.
[AGENT][POSITIVE] You're welcome.