AccountId: 011433970860
ContactId: 52837dae-d5fe-4266-8b86-b36f8463e4d8
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 406579 ms
Total Talk Time (AGENT): 183444 ms
Total Talk Time (CUSTOMER): 173625 ms
Interruptions: 4
Overall Sentiment: AGENT=0.8, CUSTOMER=1.3
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/01/09/52837dae-d5fe-4266-8b86-b36f8463e4d8_20250109T19:48_UTC.wav
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[AGENT][NEUTRAL] Thank you for calling APL. This is [PII]. How can I help you?
[CUSTOMER][NEUTRAL] Hi, Ms. [PII]. Good afternoon. It's [PII] at Doctor [PII]'s office. I'm calling um regarding a patient that we have in our office. He has uh this insurance as a secondary for him, and we just wanted to verify coverage for him. He has a co-pay with a different insurance carrier, and he's wondering if you guys will cover that co-pay for him.
[AGENT][NEUTRAL] Mhm.
[AGENT][NEUTRAL] OK, we could definitely take a look um at those, make sure that policy is getting active and what kind of policy it is uh first [PII], if I could, can I get a good call back number from you in case we're disconnected?
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Yes, ma'am. OK.
[CUSTOMER][NEUTRAL] Sure. Yes, ma'am. [PII].
[AGENT][NEUTRAL] OK thank you and then do you have the policy number?
[CUSTOMER][NEUTRAL] Yes, ma'am. It is uh 115398 39, I'm sorry, 70. So 1,153,970.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] Got it thank you and what was the name and date of birth for the insured?
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Patient is [PII]. Date of birth is [PII].
[AGENT][NEUTRAL] OK, thank you so much for verifying that information. Uh, so the policy is active. Effective date was [PII], and so yes, this is the secondary medical policy. It is designed to help with uh co-pay, deductible and co-insurance after major medical pays.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][POSITIVE] No problem.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] OK. After, after major, what, what do you mean? OK.
[AGENT][NEUTRAL] Yes.
[AGENT][NEUTRAL] So this policy is very dependent on his primary, whoever he has as his primary, so he wouldn't be able to use this instead uh if if major medical does not pay this policy cannot.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] OK. So how does he, how does it work with him as far as his, his first insurance is Cigna, which he has a $100 co-pay with Cigna if he sees a specialist. So how would this benefit him as for co-pay? He couldn't use it as a co-pay?
[AGENT][NEUTRAL] Mhm.
[AGENT][NEUTRAL] Mhm.
[AGENT][NEUTRAL] Let me double check.
[AGENT][NEUTRAL] Yes, um, that can, uh, it can help with the co-pay, um, of course I will let you know verification of coverage is not a guarantee of payment for claims, um, so the outpatient benefit he has is.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Yeah.
[AGENT][NEUTRAL] On a per occurrence.
[CUSTOMER][NEUTRAL] So it's like he has to pay, he has to pay the copay and then you guys reimburse him or?
[AGENT][NEUTRAL] cases
[AGENT][NEUTRAL] Frankly it would really depend on how the provider's office were to do that um if it's something y'all could just bill, you know, he wouldn't have to do it right then and there, but yeah, it could be worse. um, let me check first though to make sure that he does have uh coverage for you so this was a specialist office.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] Let me make sure that that's covered, um, that, that some of our policies have that benefit, some of them do not, uh, so let me check that, bear with me just a moment.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][POSITIVE] OK, thank you.
[AGENT][POSITIVE] Thank you.
[CUSTOMER][NEUTRAL] Let's check.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][POSITIVE] You're welcome.
[CUSTOMER][POSITIVE] Thanks.
[AGENT][NEUTRAL] Sorry, it is really going slow today. I think all the snow is kind of bogging it down. Just bear with me.
[CUSTOMER][POSITIVE] No, no, no problem.
[CUSTOMER][POSITIVE] No problem, no problem.
[AGENT][POSITIVE] Thank you.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Hey.
[CUSTOMER][NEUTRAL] We got
[CUSTOMER][NEUTRAL] Oh.
[CUSTOMER][NEUTRAL] Uh, um, I think someone went in there, but yes.
[CUSTOMER][NEUTRAL] Monthly.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] OK, so sorry about that wait. I appreciate your patience, [PII]. Um, OK, so he does have a benefit. Um, it does not specifically state a specialist to see a physician's office. Um, that benefit is $25 per visit that we would pay with a maximum of 4 visits per covered person, uh, per calendar year. Uh, it's not to say that treatment received in office would be considered a separate benefit.
[CUSTOMER][POSITIVE] Mhm. It's OK. No problem.
[CUSTOMER][NEUTRAL] OK
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] Um, but this is for gonna be the visit itself if that makes sense.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Yeah, so $25 towards a visit will be paid from the from the supplement insurance.
[AGENT][NEUTRAL] Right, um, and now again if treatment is received in office that would be a different benefit, but if it was just, you know, like a consultation or something like that then yeah.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Yeah, just an office visit. He saw us today, so it was just an office visit, a new patient visit. OK, OK, but it, but it really doesn't cover, uh, a co-pay per se as far as like his Cigna, he has a co-pay to see the specialist you guys wouldn't.
[AGENT][NEUTRAL] Right.
[AGENT][NEUTRAL] It's still right if it was uh something else like if he had received treatment in office um his outpatient benefit is $500 per occurrence, uh, so that could potentially go towards that if that wasn't all met or if there was uh less than that, of course, um, but as for physician's office visits, $25 is the maximum amount per visit.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][POSITIVE] $25 is the maximum visit. OK, OK, alrighty, well thank you so much for explaining that to me. No, no, no, that's OK. No, that was it. Thank you. I appreciate it.
[AGENT][NEUTRAL] Yes.
[AGENT][NEUTRAL] All right sorry I know that was a bit confusing. Yes, was there anything else I can help you with?
[AGENT][POSITIVE] Alright, yes, thanks for calling API. I hope you have a great rest of your day.
[CUSTOMER][NEUTRAL] Alright.
[CUSTOMER][POSITIVE] You too. Take care. Bye-bye. Uh-huh.
[AGENT][POSITIVE] Thank you. Bye bye. You too.