AccountId: 011433970860
ContactId: 3eee0fc1-685b-4f3d-a36f-acec103e5d51
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 318299 ms
Total Talk Time (AGENT): 176636 ms
Total Talk Time (CUSTOMER): 117117 ms
Interruptions: 8
Overall Sentiment: AGENT=0.5, CUSTOMER=0.6
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/03/24/3eee0fc1-685b-4f3d-a36f-acec103e5d51_20250324T13:13_UTC.wav
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[AGENT][NEUTRAL] For calling APL, this is [PII]. How may I assist you?
[CUSTOMER][NEUTRAL] Hey, I'm trying to verify coverage for a patient please eligibility.
[AGENT][POSITIVE] Sure, I can assist you with that. Can I have your name and a callback number?
[CUSTOMER][NEUTRAL] Uh, my name is [PII] and the number is [PII].
[AGENT][NEUTRAL] And what is the member's policy number that you're calling to verify eligibility for?
[CUSTOMER][NEUTRAL] Um, it is 0256.
[CUSTOMER][NEUTRAL] 9257.
[CUSTOMER][NEUTRAL] 569257.
[AGENT][NEUTRAL] Thank you. Can you verify that patient's name and date of birth and I'll be able to assist you.
[CUSTOMER][NEUTRAL] Um, yes, ma'am. This patient's name is [PII]. Date of birth is [PII].
[AGENT][NEUTRAL] And this is for medical?
[CUSTOMER][NEUTRAL] Um, yes, it's medical.
[AGENT][NEUTRAL] [PII]'s policy has been active since [PII] and it's currently active.
[AGENT][NEUTRAL] In the place of services, outpatient, inpatient, office visit?
[CUSTOMER][NEUTRAL] Got it.
[CUSTOMER][NEUTRAL] It'd be an office visit place of service 11.
[AGENT][NEUTRAL] The member's policy does not cover office visits, however, it does cover.
[AGENT][NEUTRAL] The treatment received in the office under the outpatient benefits of $500.
[CUSTOMER][NEUTRAL] I'm
[CUSTOMER][NEUTRAL] Say OK, so it does not cover office visits, but your your your phone was going.
[AGENT][NEUTRAL] No, it does not cover the office visit.
[CUSTOMER][NEUTRAL] OK, and what else did you say after that?
[AGENT][NEUTRAL] So it doesn't cover office visits, however, it does cover the treatment received in the office and it falls under the outpatient benefit of $500 per calendar day.
[AGENT][NEUTRAL] And this is not a guarantee of.
[CUSTOMER][NEUTRAL] OK, now what do you mean that it covers the the treatment of an office?
[AGENT][NEUTRAL] Just disclaimer on the policy coverage. So meaning as in the office visit itself to see the itself is not covered, but the treatment received in the office say if he get a shot.
[CUSTOMER][POSITIVE] All right, stand right there for me, honey. I'll see how much you weigh.
[CUSTOMER][NEUTRAL] OK, uh, you're, I'm I'm, I.
[CUSTOMER][NEUTRAL] Yes, I don't know if you got me on speakerphone, but I, I'm only getting part of your words. Can you please repeat that?
[AGENT][NEUTRAL] I don't
[AGENT][NEUTRAL] I'm not
[AGENT][NEUTRAL] I'm not sure what's going on with the foam. However, the treatment received in the office is considered as if he get a shot or if he get his arm wrapped up or if the doctor checks him for a sinus infection, those are considered as the treatment received in the office.
[CUSTOMER][POSITIVE] Good
[AGENT][NEUTRAL] I'm not sure if you were able to hear me.
[CUSTOMER][NEUTRAL] And it's $500.
[CUSTOMER][NEUTRAL] It's $500 per visit, is that what you said?
[AGENT][NEUTRAL] $500 per day.
[CUSTOMER][NEUTRAL] Per day
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] So
[CUSTOMER][NEUTRAL] So it doesn't cover medical.
[CUSTOMER][NEUTRAL] It's it's not a medical plan but it covers the medical.
[CUSTOMER][NEUTRAL] The doctor's visit under the outpatient plan you said?
[AGENT][NEUTRAL] Well, no, I never said it wasn't a medical plan because this is a gap insurance for the member's policy to the primary. I just stated that it does not cover office visits.
[AGENT][NEUTRAL] Just the office visit is not covered.
[CUSTOMER][NEUTRAL] OK, but now the, the this, this, OK, but now this is the patient's primary.
[AGENT][NEUTRAL] No, this is not the patient's primary. We can never be the primary because this is the second, this is a gap insurance.
[CUSTOMER][NEUTRAL] Mm, no, mom said that they this that this is their primary.
[AGENT][NEUTRAL] Ma'am.
[AGENT][NEUTRAL] I'm just
[AGENT][NEUTRAL] I don't know what to tell you because I work here at American Public Life and this is a gap insurance we do not offer a primary insurance here, so they have a gap in in order for them to have a gap insurance policy, they definitely have a primary insurance.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] Not sure who it with, but this is the gap insurance.
[CUSTOMER][NEUTRAL] OK, so basically, so, uh, OK, so this, this plan can never be a primary plan is what you're telling me because it's a gap plan.
[AGENT][NEUTRAL] That is right, that is correct. This policy only helps with the primary with the deductible copay, coinsurance for services that goes towards their deductible copay and co-insurance.
[CUSTOMER][NEUTRAL] OK
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] So I'm not sure my mom stated that because it's not a primary insurance. This is a gap insurance.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Got it. I just, I've never heard of a gap insurance so that's why I was, I was questioning what that is, um.
[AGENT][NEGATIVE] I wish I had one cause it helps with your deductible for your primary.
[CUSTOMER][NEUTRAL] Yes, for sure, yes, for sure, OK, um, OK, I guess that's the only, yep, I guess that's the only information I need for right now and what was your name again?
[AGENT][NEUTRAL] $500 a day, that's.
[AGENT][NEUTRAL] No.
[AGENT][NEUTRAL] My name is [PII], and I totally forgot your name. What was yours?
[CUSTOMER][NEUTRAL] My yeah my name is [PII].
[AGENT][POSITIVE] Thank you and is there anything else that I can assist you with?
[CUSTOMER][NEUTRAL] Is there like a call reference number for today's call or?
[AGENT][NEUTRAL] We don't provide reference numbers in, but you can use my name in today's date as a reference.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][POSITIVE] Yep, that'd be perfect. Um, yep, that's all I needed Ms. [PII], thank you so much for your time and your help. I really do appreciate it.
[AGENT][POSITIVE] You're welcome thanks for calling APL and have a great day.
[CUSTOMER][POSITIVE] You too thank you bye.
[AGENT][POSITIVE] Thanks. Goodbye.