AccountId: 011433970860
ContactId: 436c3206-c1ed-4281-8a9c-9ce9d4b4817b
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 277260 ms
Total Talk Time (AGENT): 125267 ms
Total Talk Time (CUSTOMER): 87547 ms
Interruptions: 2
Overall Sentiment: AGENT=0.3, CUSTOMER=0.2
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/02/24/436c3206-c1ed-4281-8a9c-9ce9d4b4817b_20250224T19:58_UTC.wav
--------------------------------------------
[AGENT][POSITIVE] Thank you for. This is [PII]. How may I help you?
[CUSTOMER][NEUTRAL] Hello?
[CUSTOMER][NEUTRAL] Yes, hi, [PII]. I'm calling for Doctor [PII]'s office. I need to go over a patient's gap plan, please.
[AGENT][NEUTRAL] OK, one moment.
[CUSTOMER][NEUTRAL] Hello?
[AGENT][NEUTRAL] Yes, one moment please.
[CUSTOMER][NEUTRAL] Yeah
[AGENT][NEUTRAL] And if you could spell your name for me?
[CUSTOMER][NEUTRAL] [PII]
[AGENT][NEUTRAL] And [PII], what's the policy number and a good phone number in case we're disconnected?
[CUSTOMER][NEUTRAL] The policy number is 02462027ML8.
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Phone number is [PII].
[AGENT][NEUTRAL] OK, and what's the patient's name and date of birth?
[CUSTOMER][NEUTRAL] Patient is [PII] [PII].
[AGENT][NEUTRAL] Alright, thanks for verifying the information for me and you said you're just wanting to verify eligibility?
[CUSTOMER][NEUTRAL] Yes, I need to know um if this plan is going to cover the patient's um deductible, which is primary plan because the patient has a deductible with the primary plan. Any procedures rendered in the doctor's office would be the patient's responsibility. So is this gap plan going to pick up the procedures that are rendered in the office?
[AGENT][NEUTRAL] OK, I was just trying to confirm the reason for your call, so now we will check eligibility and then treatment in the office, OK? Give me one moment.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] They show the policy effective date is [PII]. It is currently active at this time.
[AGENT][NEUTRAL] And there is a treatment right under this plan and did you say it's outpatient just well you said it's in the office. What type of treatment is it for?
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] The patient was to do a biopsy in the office, a procedure, would this gap plan cover the procedure engine in the office?
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] I understand the question. I was verifying what type of procedure you provided that information. So now I'll give you the outpatient benefit, which is up to $1000. That is per calendar day.
[AGENT][NEUTRAL] And any information provided is verification, not a guarantee of payment. And did you have any other questions, [PII]?
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Well, I need to know you're gonna cover the procedures in the office or no?
[AGENT][NEUTRAL] Covered procedures up to the 1000 per calendar year since this policy is secondary.
[CUSTOMER][NEUTRAL] So the patient has benefits up, yeah, so you cover up to 1000 per year?
[AGENT][NEUTRAL] Census
[AGENT][NEUTRAL] Per calendar day. I'm sorry, it's up to $1000 per calendar day.
[CUSTOMER][NEUTRAL] For calendar day.
[AGENT][NEUTRAL] And since this policy is secondary to the major medical policy, um, it will, it will cover up to 1000 per calendar day of covered charges that are applied towards deductible, co-insurance, and co-pay amounts.
[CUSTOMER][NEUTRAL] OK
[CUSTOMER][NEUTRAL] OK, so the one
[CUSTOMER][NEUTRAL] The 1000 a day.
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Excuse me.
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Is for procedures rendered in the office, not for a copay for an office visit co-pay.
[AGENT][NEUTRAL] The office visit or the physician's visit isn't covered.
[AGENT][NEUTRAL] For treatment in the office only.
[CUSTOMER][NEUTRAL] Right, because you said copay, it's just, it's just for the procedure.
[AGENT][NEUTRAL] The physician visit fee is not covered.
[CUSTOMER][NEUTRAL] Right, it's just for the procedure because you had mentioned that it covers the copay.
[AGENT][NEUTRAL] And it
[AGENT][NEUTRAL] Yeah, so sometimes the first.
[CUSTOMER][NEUTRAL] So it's just a procedure that's covered, right, OK, so let me.
[AGENT][NEUTRAL] Yes, just a procedure in the office.
[CUSTOMER][NEUTRAL] So let me have a reference number that the procedure in the office will be covered.
[AGENT][NEUTRAL] And again, this is just a verification. It doesn't guarantee payment of a claim until we receive the actual documents. You'll use my name and today's date as reference for today's call. That's [PII].
[AGENT][NEUTRAL] [PII] first initial last name is [PII]. And any other questions, [PII]?
[CUSTOMER][POSITIVE] No, that would be all thank you all right bye bye thank you bye.
[AGENT][POSITIVE] You're welcome. Thank you for calling. Have a good day.