AccountId: 011433970860
ContactId: 326346d9-b47b-4ce5-a459-4f9f9e9e5b66
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 202169 ms
Total Talk Time (AGENT): 80099 ms
Total Talk Time (CUSTOMER): 111617 ms
Interruptions: 0
Overall Sentiment: AGENT=0.7, CUSTOMER=0.4
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/05/16/326346d9-b47b-4ce5-a459-4f9f9e9e5b66_20250516T15:48_UTC.wav
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[AGENT][POSITIVE] Good morning. Thanks for calling APL. This is [PII]. May I help you?
[CUSTOMER][NEUTRAL] Hi, yes, good morning. My name is [PII] and I'm calling from a provider's office because I have one of your members coming in for a specialist office visit, and I was wondering if you guys would cover the primary insurance's deductible.
[AGENT][NEUTRAL] OK, I can verify benefits for you and, uh, Lord, words are her. [PII], what's that policy number, please?
[CUSTOMER][NEUTRAL] I have here 02510864.
[CUSTOMER][NEUTRAL] M as in Mary, L as in Larry, and the number 8.
[AGENT][POSITIVE] OK, thank you so much. And do you have a callback number in case the call drops?
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] OK. And the patient's name, date of birth?
[CUSTOMER][NEUTRAL] Um, the, so it looks like um it's under her husband's plan, [PII]. I don't have his date of birth, but I have the wife's date of birth with, I don't, I don't know if she reflects on their [PII].
[AGENT][NEUTRAL] OK. And what is her date of birth?
[CUSTOMER][NEUTRAL] [PII] [PII].
[AGENT][NEUTRAL] OK, thank you. And showing her effective date is [PII]. She is active on the policy. And you say you're calling for office visit benefits?
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Um, yes, to see if it would cover, um, the copay or the or the deductible from her primary insurance.
[AGENT][NEUTRAL] OK. Well, not for the office visit, but she does have an outpatient, uh, office treatment rider that covers procedures in the office as outpatient, but not the visit itself.
[CUSTOMER][NEUTRAL] OK, OK.
[CUSTOMER][NEUTRAL] Got it. OK, perfect. And then for the um exams that are covered, is there a limit that you guys cover or?
[AGENT][NEUTRAL] Uh, there's a benefit max per year for outpatients.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK, if you wouldn't mind, may I get that please?
[AGENT][NEUTRAL] Uh yes, sir. Um, not a guarantee of payment, just a verification of coverage. Um, we will pick up what primary applies for deductible, co-pay, and or co-insurance up to $2000 per calendar year.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] OK, $2000.
[CUSTOMER][NEUTRAL] And has she met any of that outpatient thus far?
[AGENT][NEUTRAL] Um, let's see.
[AGENT][NEGATIVE] Uh, no, sir. So far she hasn't used any benefits for this year.
[CUSTOMER][NEUTRAL] Hello
[CUSTOMER][NEUTRAL] OK, and then let me just try to reiterate once she meets that [PII] you guys wouldn't cover any of the outpatient visits?
[AGENT][NEUTRAL] Correct. Once she's met that benefit max for the year, then there's no more benefits for outpatient. Mhm.
[CUSTOMER][NEUTRAL] OK
[CUSTOMER][NEUTRAL] Got it
[CUSTOMER][POSITIVE] OK, perfect. OK, alright, and may I just get your name one more time and then that is pretty much it for our phone call. Thank you so much.
[AGENT][NEUTRAL] Uh yes, sir. It's [PII], last initial [PII]
[CUSTOMER][NEUTRAL] Mm
[CUSTOMER][POSITIVE] OK perfect thank you so much, [PII]. You enjoy the rest of your day.
[AGENT][POSITIVE] Oh, you too, and thanks for calling APO Mr. [PII]. Have a great weekend.
[CUSTOMER][NEUTRAL] Bye bye.