AccountId: 011433970860
ContactId: 47d3f11e-3754-485b-8166-5b98f8b95474
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 226600 ms
Total Talk Time (AGENT): 98427 ms
Total Talk Time (CUSTOMER): 102354 ms
Interruptions: 0
Overall Sentiment: AGENT=1.1, CUSTOMER=2.6
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/05/28/47d3f11e-3754-485b-8166-5b98f8b95474_20250528T17:54_UTC.wav
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[AGENT][POSITIVE] Good afternoon. Thank you for calling APL. My name is [PII]. How may I help you?
[CUSTOMER][NEUTRAL] Hi, good afternoon. My name is [PII]. I'm calling from Vital MD, and I need to get benefits on a patient, please.
[AGENT][POSITIVE] OK, I can definitely help you with the benefits and [PII], may I have a good contact number in case we're disconnected and the policy number?
[CUSTOMER][NEUTRAL] Uh yes, it's [PII]. And the policy number is 02605890ML8.
[AGENT][NEUTRAL] Thank you. And can you verify the member's first and last name and date of birth?
[CUSTOMER][NEUTRAL] It's [PII], [PII].
[AGENT][NEUTRAL] Thank you, and all the information provided is a verification of benefits, not a guarantee of payment. So I am showing the policy is active. It's been effective since [PII]. And what type of benefits did you want to go over today?
[CUSTOMER][NEUTRAL] Um, patient is coming, um, for her wellness, but for her, um, a sick office visit, she has a copay and for ultrasound is subject to her deductible with her primary insurance. So I wanna know if you guys will cover deductible in office.
[AGENT][NEUTRAL] Wait a minute.
[AGENT][NEUTRAL] She's coming in for a wellness visit in the office?
[CUSTOMER][NEUTRAL] No, no, no, she's coming for her wellness, but I'm getting benefits for everything. So, for a sick of his visit, it's a co-pay and for diagnostic ultrasound will be subject to deductible. So I just want to know if you guys cover the co-pay for this in the like a physical pay or if you also cover ultrasound, surgery, anything in office.
[AGENT][NEUTRAL] OK, so for outpatient, the, the max is $6000 per calendar year.
[AGENT][NEUTRAL] There's no in-office coverage on the policy. It's only outpatient and inpatient, but she does have the office treatment rider, so any treatment in the office could be covered up to that 6000 per calendar year.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK, so she has 4 in office.
[AGENT][NEUTRAL] Did you want me to see
[AGENT][NEUTRAL] I'm sorry?
[CUSTOMER][NEUTRAL] But probably not copay, right?
[AGENT][NEUTRAL] We pay towards the co-pay, deductible and co-insurance after primary up to the 6000 per calendar year.
[CUSTOMER][NEUTRAL] OK. So any co-pay?
[AGENT][NEUTRAL] Did you want me
[CUSTOMER][NEUTRAL] Go ahead, go ahead.
[AGENT][NEUTRAL] No, you can continue.
[CUSTOMER][NEUTRAL] Um, no, so I just wanna make sure if she does, uh, diagnostic ultrasound in the office or any surgery in the office or the co-pay will be covered up to 6000.
[AGENT][NEUTRAL] Could be covered. Um, yes, up to the $6000 per calendar year, the office treatment rider would take care of or should take care of any of the treatment in the office.
[CUSTOMER][NEUTRAL] Oh OK.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][POSITIVE] Perfect. And any of the 6000 have been used?
[AGENT][NEUTRAL] She's used $108.66. She has $5,891.34 left for the year.
[CUSTOMER][POSITIVE] Perfect.
[CUSTOMER][POSITIVE] OK. Thank you very much for your help. And can I have a reference number, please?
[AGENT][NEUTRAL] Sure, so there's no call reference number, but you can use my name in today's date. And again, that's [PII], first initial to my last name is [PII], and then today's date.
[CUSTOMER][POSITIVE] Thank you.
[AGENT][NEUTRAL] You're welcome, [PII]. Was there anything else I can assist you with today?
[CUSTOMER][POSITIVE] No, that will be all. Thank you.
[AGENT][POSITIVE] All right. You're welcome. Thanks for calling APL. Bye-bye.
[CUSTOMER][NEUTRAL] Mm bye bye.