AccountId: 011433970860
ContactId: 48fd3423-d1f3-414a-ba2d-92891bb32042
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 283750 ms
Total Talk Time (AGENT): 99044 ms
Total Talk Time (CUSTOMER): 127233 ms
Interruptions: 0
Overall Sentiment: AGENT=0.3, CUSTOMER=0.6
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/06/09/48fd3423-d1f3-414a-ba2d-92891bb32042_20250609T19:45_UTC.wav
--------------------------------------------
[AGENT][NEUTRAL] Good morning. Thank you for calling APL. This is speaking. May I help you?
[CUSTOMER][NEUTRAL] Hi, this is [PII] from doctor's office. I'm a patient. I want to confirm the eligibility and benefits for specialist office visit. Can you please assist me?
[AGENT][NEUTRAL] Sure, to verify benefits and eligibility for you. And you said your name is [PII]?
[CUSTOMER][POSITIVE] Yes, of course.
[AGENT][NEUTRAL] OK, and the policy number?
[CUSTOMER][NEUTRAL] Yes, the policy number is 60801.
[AGENT][NEUTRAL] No, sir. That is not a policy number, that's a payer ID number. Do you have a copy of the card in front of you?
[CUSTOMER][NEUTRAL] Uh, wait, give me a second, kindly.
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Yes
[CUSTOMER][NEUTRAL] Yeah
[CUSTOMER][NEUTRAL] just
[CUSTOMER][NEUTRAL] Yes, I have the uh ID number is starting from.
[CUSTOMER][NEUTRAL] It's uh 02315574 ML8.
[AGENT][NEUTRAL] OK, thank you. And do you have a callback number in case the call drops?
[CUSTOMER][NEUTRAL] Yes, it's [PII] direct line.
[AGENT][NEUTRAL] OK, and verify the patient's name, date of birth.
[CUSTOMER][NEUTRAL] Yes, the patient name is [PII] and date of birth is, it's [PII].
[AGENT][NEUTRAL] OK, thank you. I'm showing an effective date of [PII], policy is active.
[AGENT][NEUTRAL] Uh, one moment. And as far as office visits are not covered under the policy.
[CUSTOMER][NEUTRAL] OK. And actually, I want to know that the infusions are performed by the specialist like J11756 are covered under this patient plan or not?
[AGENT][NEUTRAL] If procedures are performed in a doctor's office or clinic, the patient does have a writer that covers procedures as outpatient, as long as for sickness or an injury and it's covered by the primary.
[CUSTOMER][NEUTRAL] OK, means that uh these infusions are covered if the primary insurance are covered them as well. Am I correct?
[AGENT][NEUTRAL] As I said, with a procedure, if it's performed in a doctor's office or clinic and it's for a sickness or an injury and it's covered by the primary, it could be covered under this policy as outpatient.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK. OK. Miss, uh, means, the, the directly specialist office visits are not covered, but this, uh, infusions performed in office are covered. Am I correct?
[AGENT][NEUTRAL] Procedures in office are covered under the policy, but the visit itself is not covered.
[CUSTOMER][NEUTRAL] OK. OK. So is not covered. Also, please provide me the uh out of pocket's maximum limit for outpatient.
[AGENT][NEUTRAL] Um, not a guarantee of payment, just verification of coverage. Patient has a benefit max up to $7350 per calendar year.
[CUSTOMER][NEUTRAL] $7350. OK, $7350. And uh what is the uh net amount?
[AGENT][NEUTRAL] Uh, the patient hasn't used any benefits for outpatient, so it is available.
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] All available.
[CUSTOMER][NEUTRAL] OK. And the uh uh the, if primary insurance left some responsibility as a like co-pay, co-insurance, and uh deductibles are also covered?
[AGENT][NEUTRAL] That's what we pick up as secondary deductible, co-pay or co-insurance for the procedures up to that $7350 benefit.
[CUSTOMER][NEUTRAL] Yes
[CUSTOMER][POSITIVE] OK, thank you so much. Please provide me the reference number kindly.
[AGENT][NEUTRAL] Uh, you may use my name at today's date.
[CUSTOMER][NEUTRAL] Can you please repeat your name for me one time?
[AGENT][NEUTRAL] Sure, it's [PII], last initial and it's [PII]
[CUSTOMER][POSITIVE] OK. Thank you so much, [PII], for providing me that useful information. Have a nice day. Take care.
[AGENT][NEUTRAL] Um
[AGENT][POSITIVE] You're welcome thanks for calling APL. bye.
[AGENT][NEUTRAL] Uh