AccountId: 011433970860
ContactId: 4d29b8aa-9a9d-44a4-8348-1b805e9c1081
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 763549 ms
Total Talk Time (AGENT): 285576 ms
Total Talk Time (CUSTOMER): 317802 ms
Interruptions: 8
Overall Sentiment: AGENT=0.6, CUSTOMER=0.3
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/02/07/4d29b8aa-9a9d-44a4-8348-1b805e9c1081_20250207T19:38_UTC.wav
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[AGENT][NEUTRAL] Good afternoon. Thank you for calling American Public Life. This is [PII]. How may I help you?
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] Hi, this is [PII] calling from provider's office.
[CUSTOMER][NEUTRAL] How are you?
[AGENT][NEUTRAL] I'm just fine, thank you, [PII], and how, and you're with the provider's office?
[CUSTOMER][NEUTRAL] Yeah, I'm calling from provider's office. I just need to verify the eligibility status and benefits coverage for.
[AGENT][NEUTRAL] You
[CUSTOMER][POSITIVE] Mm I want benefits also.
[AGENT][NEUTRAL] You need to verify
[AGENT][NEUTRAL] You need to verify benefits and eligibility?
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Yeah, I, I, I need benefits coverage for office, a specialist office visit and diagnostic lab.
[AGENT][NEUTRAL] OK, so you're needing uh to verify benefits for diagnostic lab and special specialist office visits?
[CUSTOMER][NEUTRAL] Mhm
[CUSTOMER][NEUTRAL] Yeah, yeah, right.
[AGENT][NEUTRAL] OK, and sir, what provider's office are you with?
[CUSTOMER][NEUTRAL] Mm.
[CUSTOMER][NEUTRAL] Uh, Stewart oncology Associates.
[AGENT][NEUTRAL] OK. And what was the first one before oncologist?
[CUSTOMER][NEUTRAL] Yeah, it's for oncology, oncology and hematology.
[AGENT][NEUTRAL] OK, and what is the name of the what is the facility's name? Can you spell the first name of that facility?
[CUSTOMER][NEUTRAL] Specialty.
[CUSTOMER][NEUTRAL] Mhm
[CUSTOMER][NEUTRAL] Yeah, it's [PII], S T U A R T, Stewart Oncology Associates.
[AGENT][NEUTRAL] OK, thank you, [PII]. [PII], what is a good callback number in case we get disconnected?
[CUSTOMER][NEUTRAL] Yeah, it's it's [PII].
[CUSTOMER][NEUTRAL] [PII]
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] Thank you, [PII]. And what is the policy number of the insured?
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] Oh, it's.
[CUSTOMER][NEUTRAL] 08, sorry, sorry, sorry. I'm wrong. 018.
[CUSTOMER][NEUTRAL] 291
[CUSTOMER][NEUTRAL] 00
[CUSTOMER][NEUTRAL] M as in Mike.
[CUSTOMER][NEUTRAL] Yeah, Lima.
[CUSTOMER][NEUTRAL] 8
[AGENT][NEUTRAL] OK, and what's the name of the insured?
[CUSTOMER][NEUTRAL] It's uh what is it.
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] OK, and what is his date of birth?
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] Wait a minute. It's
[CUSTOMER][NEUTRAL] It's [PII].
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] OK, so, and what's the first name of the of the patient?
[CUSTOMER][NEUTRAL] Uh, uh, one second, hold on. I need to check that.
[CUSTOMER][NEUTRAL] It's [PII].
[AGENT][NEUTRAL] And what is, what is, what's the date of birth?
[CUSTOMER][NEUTRAL] Hello ma'am.
[CUSTOMER][NEUTRAL] Yeah, it's uh [PII].
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] OK.
[AGENT][POSITIVE] Thank you.
[CUSTOMER][POSITIVE] Mhm. You're welcome.
[AGENT][NEUTRAL] And the, the policyholder, the insured is [PII], correct?
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Yeah.
[AGENT][NEUTRAL] And uh and but the patient is [PII].
[CUSTOMER][NEUTRAL] Yeah, right.
[AGENT][NEUTRAL] OK. Thank you, [PII]. And you're wanting to verify benefits for diagnostic lab and also special office visits, correct?
[CUSTOMER][POSITIVE] Yeah, yeah, correct.
[AGENT][POSITIVE] OK, sure. Thank you. And I'll be happy to help you with that. Give me just a few minutes while I pull this policy up.
[CUSTOMER][POSITIVE] Yeah, OK. It's, it's OK. Uh, take your time.
[AGENT][NEUTRAL] OK, now this call is not a guarantee and benefits. I'm just go and it's not an approval of benefits. I'm just going over um eligibility. The effective date is [PII].
[CUSTOMER][NEUTRAL] Mm
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][POSITIVE] The coverage is active.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] The policy is a medical supplemental policy.
[AGENT][NEUTRAL] That it covers um co-pay, deductibles and co-insurance that covered outpatient services.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] Um, for treatment that's in in a hospital emergency room, urgent care facility, surgery, and hospital outpatient facility.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] Um,
[AGENT][NEUTRAL] Independent diagnostic testing.
[AGENT][NEUTRAL] Um, in a hospital.
[CUSTOMER][NEUTRAL] Hm.
[AGENT][NEUTRAL] Or outpatient hospital outpatient facility or MRI facility. Outpatient treatment for mental health.
[CUSTOMER][NEUTRAL] Uh,
[CUSTOMER][NEUTRAL] Uh, for diagnostic lab, it's, uh, it's, it's office visit for office visit.
[AGENT][NEUTRAL] OK, it doesn't cover any office visit fee and it doesn't cover um if services are in an office, a physician's office.
[CUSTOMER][NEUTRAL] Oh.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] And it doesn't cover any type of office visit fee?
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][POSITIVE] It does have an independent lab facility benefit that is done at an independent lab facility such as blood work.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] Um, for diagnostic testing.
[AGENT][NEUTRAL] But it would have to be in an independent lab facility.
[CUSTOMER][NEUTRAL] Hm.
[AGENT][NEUTRAL] There is also a diagnostic testing benefit um for MRI, colonoscopy.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Mm.
[AGENT][NEUTRAL] Um,
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] Give me one minute, let me get to that area.
[CUSTOMER][NEUTRAL] Uh, for diagnostic lab, it's general, not MRI scan, an MRI lab.
[CUSTOMER][NEUTRAL] Mhm
[AGENT][NEUTRAL] Give me one minute, please.
[CUSTOMER][NEUTRAL] OK, OK.
[AGENT][NEUTRAL] Um, there, it doesn't cover any physician's office. It does have an office treatment rider.
[AGENT][NEGATIVE] But it doesn't cover, cover the fee, the physician fee?
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] And any type of diagnostic testing would have to be at an independent lab.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] Or MRI facility.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Uh, also for blood test and X-ray like that right uh so uh.
[AGENT][NEUTRAL] Parts, could you please repeat that?
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] Yeah, it's for, uh, it's, it's, it's good for uh blood test, uh, for general blood test or
[CUSTOMER][NEUTRAL] Mm, I.
[AGENT][NEUTRAL] If it's an independent lab, yes, at an independent lab.
[CUSTOMER][NEUTRAL] OK, OK. It depends on the specialist office visit, right? If, if, if the patient, uh,
[AGENT][NEGATIVE] But it does not cover anything for, it doesn't have anything for physician fees.
[CUSTOMER][NEUTRAL] OK. If the patient uh take the treatment, mm.
[CUSTOMER][NEUTRAL] OK. Uh, for, for understanding, uh,
[CUSTOMER][NEUTRAL] Uh, if, if the patient take treatment from special uh physicist or, uh,
[AGENT][NEUTRAL] It
[CUSTOMER][NEUTRAL] Yeah.
[AGENT][NEUTRAL] If it's at a, if it's treatment.
[CUSTOMER][NEUTRAL] Yeah, it's, this plan is uh
[AGENT][NEUTRAL] If the treatment has to be.
[CUSTOMER][NEUTRAL] OK, this plan does not cover, right, right?
[AGENT][POSITIVE] Right, correct.
[CUSTOMER][NEUTRAL] OK. OK. Also, for lab, if the patient take the treatment from this uh lab does not cover, right?
[AGENT][NEUTRAL] And this call is not a guarantee and benefit.
[AGENT][MIXED] Correct. It only covers if it's an independent lab.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK. Uh,
[CUSTOMER][NEUTRAL] Uh, uh, can you please hold on, uh, uh, uh, 2 minutes, wait a minute.
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Hi, ma'am.
[AGENT][NEUTRAL] Yes.
[CUSTOMER][NEUTRAL] Yeah. Uh, uh, day after before, uh, my colleague also called for, uh, for this, uh, for this plan. Uh, they said, uh, for, for per day visit, they need to pay 500 co-pay, uh, for, um, for
[CUSTOMER][NEUTRAL] For, for each uh visit per day.
[CUSTOMER][NEUTRAL] Yeah
[AGENT][NEUTRAL] It's a, the, the maximum payable benefit is, let me, let me, OK.
[CUSTOMER][NEUTRAL] Uh yeah. Uh, I read that, yeah, yeah, I, I read that. Plan covers, uh, wait a, yeah, plan covers.
[AGENT][NEUTRAL] $500. It's $500 per covered person per calendar day for covered outpatient services.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] That is of the co-pay and deductible and co-insurance of the major medical of approved services.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] Or covered outpatient services.
[CUSTOMER][NEUTRAL] Uh
[CUSTOMER][NEUTRAL] Can you please repeat that uh for, for understanding, please?
[AGENT][NEUTRAL] The the outpatient benefit maximum is $500 per covered person per calendar day for covered outpatient services.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Mhm. Mhm.
[CUSTOMER][NEUTRAL] OK, per calendar day, OK.
[CUSTOMER][NEUTRAL] For outpatient visit, OK.
[CUSTOMER][NEUTRAL] Uh, uh, if we need to, uh, pay for, uh, each.
[CUSTOMER][NEUTRAL] Right?
[CUSTOMER][NEUTRAL] Once a patient treatment uh treat uh patient get treatment uh for uh same day for office visit and diagnostic lab in outpatient, it covers.
[AGENT][NEUTRAL] No, the maximum is, it's maximum per day.
[CUSTOMER][NEUTRAL] Yeah.
[AGENT][NEUTRAL] $500 per day.
[CUSTOMER][NEUTRAL] OK, maximum.
[AGENT][NEUTRAL] It's $500 per day. I've covered.
[CUSTOMER][NEUTRAL] OK. OK.
[CUSTOMER][NEUTRAL] Uh
[AGENT][NEUTRAL] Outpatient services.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Uh, just once, right? Uh, for $500 right? For per day?
[AGENT][NEUTRAL] Right, it's maximum per day.
[CUSTOMER][NEUTRAL] OK, OK. Uh mm.
[CUSTOMER][NEUTRAL] Uh,
[CUSTOMER][NEUTRAL] Uh, OK.
[CUSTOMER][NEUTRAL] It's for each uh or uh total.
[CUSTOMER][NEUTRAL] Like, um, office visit 5 $500 and diagnostic lab $500.
[AGENT][NEUTRAL] So it would only cover $500 per day, per day.
[CUSTOMER][NEUTRAL] Oh, total. OK. OK. OK. OK. I understand, I understand.
[AGENT][NEUTRAL] Not per service, it's per day.
[CUSTOMER][NEUTRAL] Oh, OK, where the aircraft. OK. Sorry, sorry.
[CUSTOMER][NEUTRAL] And your name, ma'am?
[AGENT][NEUTRAL] My name is [PII].
[AGENT][NEUTRAL] Reference numbers today date in my name.
[CUSTOMER][NEUTRAL] And
[CUSTOMER][NEUTRAL] OK. Um, can you please spell out your name?
[AGENT][NEUTRAL] [PII]
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] [PII]
[AGENT][NEUTRAL] [PII].
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Thank you. And your, and your last initial?
[AGENT][NEUTRAL] [PII]
[CUSTOMER][POSITIVE] OK, OK, thank you, ma'am. Thank you for your assistance. Sorry for the.
[AGENT][NEUTRAL] You're welcome. And, and this calls without a guarantee and benefits. Is there anything else I can help you out with, um, [PII]?
[CUSTOMER][NEUTRAL] That's all.
[CUSTOMER][NEUTRAL] No, ma'am. No, ma'am. Thank you, thank you. That's all, ma'am. That's all.
[AGENT][POSITIVE] You're welcome, sir, and you have a wonderful day and thank you for calling American Public Life.
[CUSTOMER][POSITIVE] You too, ma'am. Have a great day. Enjoy your weekend. Bye-bye.
[AGENT][POSITIVE] Thank you.
[AGENT][POSITIVE] Thank you. Goodbye.
[CUSTOMER][POSITIVE] Thank you.