AccountId: 011433970860
ContactId: 53c105c5-777d-4859-a443-1ecfe6fb070b
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 202220 ms
Total Talk Time (AGENT): 93983 ms
Total Talk Time (CUSTOMER): 62456 ms
Interruptions: 1
Overall Sentiment: AGENT=0.8, CUSTOMER=1
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/01/28/53c105c5-777d-4859-a443-1ecfe6fb070b_20250128T15:30_UTC.wav
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[AGENT][POSITIVE] Good morning. Thank you for calling APL. My name is [PII]. How may I help you?
[CUSTOMER][NEUTRAL] Hi, and I'm calling from South Florida ENT Associates. Um, I am calling to verify the gap insurance for one of our patients that's gonna be undergoing vestibular balance testing.
[AGENT][POSITIVE] OK, well, I'll be more than happy to help you with the eligibility. Go ahead.
[CUSTOMER][NEUTRAL] Trying to see if, yep.
[CUSTOMER][NEUTRAL] Just trying to see if if the gap insurance covers the deductible of her primary plan Cigna. Can I give you the information for the patient?
[AGENT][NEUTRAL] May I have your name and a good contact number in case we're disconnected?
[CUSTOMER][NEUTRAL] Of course it's [PII].
[CUSTOMER][NEUTRAL] [PII].
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] Thank you. And your name and the member's policy number?
[CUSTOMER][NEUTRAL] My name is [PII]. The member's policy number is 02478823ML8.
[AGENT][NEUTRAL] Thank you, hold on one moment.
[CUSTOMER][POSITIVE] Alrighty.
[AGENT][NEUTRAL] And can you verify the member's first and last name and date of birth?
[CUSTOMER][NEUTRAL] Member's first name is [PII], last name [PII].
[CUSTOMER][NEUTRAL] Date of birth is [PII].
[AGENT][NEUTRAL] Thank you for that 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].
[CUSTOMER][NEUTRAL] Um
[AGENT][NEUTRAL] And our payments do go towards the copay, deductible and co-insurance of covered charges after primary. Would you all be considered outpatient?
[CUSTOMER][NEUTRAL] We are considered specialist office, so everything is done in office setting.
[AGENT][NEUTRAL] OK, hold on one moment.
[AGENT][NEUTRAL] I'm just waiting for the benefits to populate here.
[AGENT][NEUTRAL] So the policy is broken into the place of service really. So it's inpatient and outpatient and outpatient, uh,
[CUSTOMER][NEUTRAL] OK, it's considered outpatient.
[AGENT][NEUTRAL] Thank you. Under outpatient, we would pay, um, hold on one moment.
[AGENT][NEGATIVE] Up to $2000 per calendar year. Now this member does not have um any in-office.
[AGENT][NEUTRAL] Benefits, um, or the office treatment rider. So her second or the second, his secondary insurance wouldn't cover in-office settings, visits or treatment.
[CUSTOMER][NEUTRAL] OK, so then APL does not cover the deductible for their vestibular testing.
[AGENT][NEUTRAL] Right, for anything in office, um, there would be no coverage.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] What is your name?
[AGENT][NEUTRAL] My name is [PII] The [PII] is [PII].
[CUSTOMER][NEUTRAL] And is there a reference number?
[AGENT][NEUTRAL] So there's no call reference number, but you can use my name in today's date.
[CUSTOMER][POSITIVE] Alrighty thank you so much [PII] you have a great day.
[AGENT][NEUTRAL] And
[AGENT][POSITIVE] You also, and thanks for calling APL. Bye-bye.
[CUSTOMER][POSITIVE] Thank you bye bye.