AccountId: 011433970860
ContactId: 381ba3d9-6c3c-4739-8a7b-6dc085b6c31d
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 155639 ms
Total Talk Time (AGENT): 90641 ms
Total Talk Time (CUSTOMER): 44579 ms
Interruptions: 0
Overall Sentiment: AGENT=0.8, CUSTOMER=0
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/02/19/381ba3d9-6c3c-4739-8a7b-6dc085b6c31d_20250219T14:53_UTC.wav
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[AGENT][POSITIVE] And thank you for calling APL. This is [PII]. How can I help you?
[CUSTOMER][NEUTRAL] Uh, what's, what's your name again?
[AGENT][NEUTRAL] Um, it's [PII]. Um, it's spelled [PII] and my last initial is [PII].
[CUSTOMER][NEUTRAL] OK, yeah, I was calling to verify eligibility on a patient. Is this a this a medical policy?
[AGENT][NEUTRAL] Um, well, first, I'll need to look that up. Um, first, let me get your name and a good callback number.
[CUSTOMER][NEUTRAL] [PII], last initial is [PII]
[CUSTOMER][NEUTRAL] [PII]
[AGENT][NEUTRAL] OK. Thank you, [PII]. Now I need the policy number, please?
[CUSTOMER][NEUTRAL] 02156200
[AGENT][NEUTRAL] And please verify the patient's name and date of birth.
[CUSTOMER][NEUTRAL] [PII].
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] Thank you and just let me advise you that verification of coverage does not guarantee payment of claims.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] Um, the effective date on this policy was [PII] and the policy is still active. And yes, ma'am, this is a medical insurance policy for a secondary gap insurance. What we do is cover the co-pay, the co-insurance, and the deductible after the primary insurance processes the claim for covered services. Um, what type of service is this for? Is it taking place in the office or outpatient facility?
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Mhm. It's a doctor's office visit, the primary care.
[AGENT][NEUTRAL] OK, for office visits, we cover up to 2400 per calendar year and that's for the co-insurance and the deductible after the primary insurance processes the claim, but the co-pay for the office visit is not covered.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK, so you cover the, you don't cover the co-pay.
[AGENT][NEUTRAL] No, ma'am. We only cover the co-insurance and the deductible. And there is a $100 deductible that needs to be met first with us.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK, you have a call reference number?
[AGENT][NEUTRAL] Yes, for the reference number, you can use my name and today's date. Um, is there anything else that I can assist you with?
[CUSTOMER][NEUTRAL] No, ma'am, that's all.
[AGENT][POSITIVE] OK. Well, I thank you again, [PII] for calling APL. You have a great rest of your day. Mm bye.
[CUSTOMER][NEUTRAL] You too bye bye.
[AGENT][NEUTRAL] Mm OK.