AccountId: 011433970860
ContactId: 42b9a837-1d75-4038-81bc-cfb560188e7f
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 313730 ms
Total Talk Time (AGENT): 121911 ms
Total Talk Time (CUSTOMER): 82812 ms
Interruptions: 0
Overall Sentiment: AGENT=0.7, CUSTOMER=0.7
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/01/16/42b9a837-1d75-4038-81bc-cfb560188e7f_20250116T15:19_UTC.wav
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[AGENT][NEUTRAL] Thank you for calling APL. This is [PII]. How can I help you?
[CUSTOMER][NEUTRAL] I, I'm calling to see um.
[CUSTOMER][NEUTRAL] What the benefits are for a patient?
[AGENT][POSITIVE] Alright, I'm happy to check on benefits today. Do you have their policy number?
[CUSTOMER][NEUTRAL] Yes, it's
[CUSTOMER][NEUTRAL] 02249238.
[AGENT][POSITIVE] All right, thank you so much. Let me pull this up.
[AGENT][NEUTRAL] And if you don't mind, can I grab your first name and a callback number, please?
[CUSTOMER][NEUTRAL] Um, it's [PII] and a callback number will be [PII].
[AGENT][NEUTRAL] Thank you [PII]. And then what is the patient's name and date of birth?
[CUSTOMER][NEUTRAL] Uh, the patient's name is [PII]. Date of birth is [PII].
[AGENT][NEUTRAL] Thank you. So the patient's plan is active. The effective date is [PII].
[AGENT][NEUTRAL] Of [PII]. We are the secondary insurance, so this is going to cover deductible, co-pay, and co-insurance. The primary does not.
[AGENT][NEUTRAL] Patient's plan has an outpatient max that looks like a $500 calendar day.
[CUSTOMER][NEUTRAL] Does it cover um any portion of the co-payment?
[AGENT][NEUTRAL] Um, for like an office visit.
[CUSTOMER][NEUTRAL] Yes.
[AGENT][NEUTRAL] Um, it does cover copay. Let me see if it covers the office visit fee. One second.
[CUSTOMER][NEUTRAL] We're considered a specialist.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] Yeah.
[AGENT][NEUTRAL] Uh, just one moment.
[AGENT][NEUTRAL] OK, so.
[AGENT][NEUTRAL] I'm just double checking the policy because some of these cover an office visit fee and some don't.
[CUSTOMER][NEUTRAL] Right.
[AGENT][NEUTRAL] So I just want to make sure. I'm sorry for the wait, one second.
[CUSTOMER][NEUTRAL] That's OK. I wanna make sure because he's here, he said something about covering, so I need to make sure.
[AGENT][NEUTRAL] Right.
[AGENT][NEUTRAL] Yeah, some of these will state, they don't cover uh
[CUSTOMER][NEUTRAL] Did you take the card? I'm on the phone with the insurance. That's, that's why I haven't gave it to him.
[AGENT][NEUTRAL] OK, so yeah, I mean, on this one, I, it looks like it will cover the physician's office fee. I don't see anything that says it won't in the exclusions.
[AGENT][NEUTRAL] So
[CUSTOMER][NEUTRAL] Is that considered a specialist office visit or when you say physician, uh, a primary, I don't know.
[AGENT][NEUTRAL] The policy states physician's office. It does not it does not specify it has to be a primary or specialist, so.
[CUSTOMER][NEUTRAL] It covers the full visit?
[AGENT][NEUTRAL] It'll cover the deductible or the co-pay for the visit.
[AGENT][NEUTRAL] Whatever the primary doesn't because we're the secondary.
[CUSTOMER][NEUTRAL] Oh OK.
[CUSTOMER][NEUTRAL] Every time he comes in or is it just a one time? Do you know?
[AGENT][NEUTRAL] The limitation on the plan is just $1 amount per day, which is $500 per day. There's no limitation on the amount of visits.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK, I'll just put it on there and.
[CUSTOMER][NEUTRAL] And um.
[CUSTOMER][NEUTRAL] We'll bill it to you guys and go from there.
[AGENT][NEUTRAL] Yes.
[AGENT][NEUTRAL] Is there anything else I can check for you?
[CUSTOMER][POSITIVE] That would be all, thank you.
[AGENT][POSITIVE] Thank you for calling APL. Have a good day.
[CUSTOMER][POSITIVE] Thank you bye bye.
[AGENT][NEUTRAL] Bye-bye.