AccountId: 011433970860
ContactId: 443ae77f-fe81-451f-9ca7-b675e6625553
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 170779 ms
Total Talk Time (AGENT): 88358 ms
Total Talk Time (CUSTOMER): 37690 ms
Interruptions: 0
Overall Sentiment: AGENT=0.8, CUSTOMER=0.4
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/04/07/443ae77f-fe81-451f-9ca7-b675e6625553_20250407T18:46_UTC.wav
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[AGENT][NEUTRAL] For calling APL, my name is [PII]. How can I assist you today?
[CUSTOMER][NEUTRAL] Hi, my name is [PII]. I'm calling from South Lake OBGYN.
[AGENT][NEUTRAL] Hi [PII], um, I'm sorry, can you repeat? You said you were calling for.
[CUSTOMER][NEUTRAL] I'm calling from South Lake OBGYN just calling for eligibility and benefits.
[AGENT][POSITIVE] I'd be happy to assist with eligibility and benefits if I can get a good call back number for you.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] [PII]
[AGENT][NEUTRAL] And what is the policy number?
[CUSTOMER][NEUTRAL] The policy number 2 I'm sorry, 02605461.
[AGENT][NEUTRAL] Patient's name and date of birth?
[CUSTOMER][NEUTRAL] [PII] [PII].
[AGENT][NEUTRAL] Thank you for that information. Please be advised the verification of coverage is not a guarantee of payment. I do show the policy is currently active. Effective date is [PII], and I do show the per day maximum for outpatient is $4250.
[CUSTOMER][NEUTRAL] OK, um, how much is for a specialist office visit?
[AGENT][NEUTRAL] Um, it will be covered under the outpatient. However, only treatment and procedures at the visit would be covered. The co-pay associated with the physician's charges would not.
[CUSTOMER][NEUTRAL] OK, does she have any maternity benefits?
[AGENT][NEUTRAL] Maternity is a covered condition. It would just be pro the claims will be processed based on the place of service, so.
[AGENT][NEUTRAL] Any treatment and procedures that the visit will be covered under that per day maximum.
[CUSTOMER][NEUTRAL] OK, so she wouldn't have to pay anything for her office visits.
[AGENT][NEUTRAL] We're her gap insurance so we would receive the benefits after the primary processes the claim, so we received a visit for an office or a claim for an office visit.
[CUSTOMER][NEUTRAL] Mhm
[AGENT][NEUTRAL] And it has say that y'all did an ultrasound and then it also has the code for the physician's charges we're gonna pay on the ultrasound and deny for the physician's charges so only treatment and procedures are covered at the visit. The copay associated with the physician's charges would not be.
[CUSTOMER][NEUTRAL] OK, can I have a reference number?
[AGENT][NEUTRAL] Reference is just my name [PII] last initial [PII], and the date and time of the call. Was there anything else I can assist with today?
[CUSTOMER][NEUTRAL] I
[CUSTOMER][POSITIVE] No, that was it. Thank you.
[AGENT][POSITIVE] Thank you for calling APO. Have a good day.