AccountId: 011433970860
ContactId: 540ddf10-1eeb-4c1f-a420-865f1127fa93
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 358160 ms
Total Talk Time (AGENT): 164234 ms
Total Talk Time (CUSTOMER): 89389 ms
Interruptions: 0
Overall Sentiment: AGENT=0.4, CUSTOMER=0.3
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/02/19/540ddf10-1eeb-4c1f-a420-865f1127fa93_20250219T16:44_UTC.wav
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[AGENT][NEUTRAL] Thank you for calling APL. This is [PII]. How can I help you?
[CUSTOMER][NEUTRAL] Hi, my name is [PII]. I'm calling with the provider's office. I'm calling to see if we are in network with the patient's plan.
[AGENT][NEUTRAL] OK, yeah, I can get that policy pulled up and we'll see that network. Um, [PII], can I get a good call back number from you first in case we're disconnected?
[CUSTOMER][NEUTRAL] Yeah
[CUSTOMER][NEUTRAL] Yes, it's [PII].
[AGENT][NEUTRAL] Thank you. Do you have the policy number?
[CUSTOMER][NEUTRAL] Um, yes, it is going to be 02571784.
[AGENT][NEUTRAL] OK, thank you. And what was the name and date of birth for the insured?
[CUSTOMER][NEUTRAL] Um, [PII]. Date of birth is [PII].
[AGENT][NEUTRAL] Perfect, thank you for verifying that [PII]. OK, so this plan, it's a bit different, um, it is a limited indemnity medical plan, so it's not a part of a set network essentially it just pays, you know, a specific dollar amount per office visit or procedure you would just file those claims directly to us.
[CUSTOMER][POSITIVE] You're welcome.
[AGENT][NEUTRAL] And I can give you that information if you need it. We've got a mailing address, fax number and a payer ID.
[CUSTOMER][NEUTRAL] OK, yes, please.
[CUSTOMER][NEUTRAL] OK, um, I have her card. Is it the [PII]?
[AGENT][NEUTRAL] No, so that's gonna be again it's a bit confusing. This is a part of a multi plan, um, so this claims address is gonna be through us. It's APL, um, I'll give you that whenever you're ready.
[CUSTOMER][NEUTRAL] Yeah
[CUSTOMER][POSITIVE] OK, I'm ready.
[AGENT][NEUTRAL] OK, so it is [PII].
[AGENT][NEUTRAL] And that is in [PII].
[AGENT][NEUTRAL] Zip code is [PII].
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK, was that [PII]?
[AGENT][NEUTRAL] I'm sorry.
[CUSTOMER][NEUTRAL] Was that [PII]?
[AGENT][NEUTRAL] [PII], sorry.
[AGENT][NEUTRAL] [PII].
[CUSTOMER][NEUTRAL] OK
[CUSTOMER][NEUTRAL] OK, and then just to make sure you said it was [PII].
[AGENT][NEUTRAL] Yes, in [PII], and then did you need that fax ID and payer ID or I'm sorry, fax number and payer ID as well?
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Yes, please.
[AGENT][NEUTRAL] Sure, fax number is [PII].
[AGENT][NEUTRAL] [PII].
[AGENT][NEUTRAL] [PII].
[CUSTOMER][NEUTRAL] OK, so [PII].
[AGENT][POSITIVE] Correct.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] Alright, and then that payer ID is 60801.
[CUSTOMER][NEUTRAL] 60801.
[AGENT][NEUTRAL] Yes.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] And then um for her specific plan that she has um what does it cover?
[AGENT][POSITIVE] For what was I'm so sorry what was that?
[CUSTOMER][NEUTRAL] Uh, for her plan that she has, what does it cover like for the office visit, how much um is paid for each office visit?
[AGENT][NEUTRAL] Mhm.
[AGENT][NEUTRAL] Sure, give me just a moment, let me get that policy pulled up to make sure they are all a bit different, so let me get that.
[CUSTOMER][NEUTRAL] Um
[AGENT][NEUTRAL] OK, and of course I will let you know verification of coverage is not a guarantee of payment for claims, uh, so office visits pay at $50 per day is the benefit amount, um, and this is just for a regular physician's office, is that correct?
[CUSTOMER][NEUTRAL] Um, it'll be an OBGYN office.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] So the reason I ask is they are separated um emergency room urgent care physician's office, um.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] And then physical therapy, so it's.
[CUSTOMER][NEUTRAL] Yeah, we would be considered specialists then.
[AGENT][NEUTRAL] OK, I think that would still fall under the physician's office. Um, I could get clarification though, but it is limited to 4 days, um, per calendar year per covered person, of course, for $50. So, and I, let me just double check. I know we're still kind of early in the year, but I can see if any of that has been used.
[CUSTOMER][NEUTRAL] OK
[AGENT][NEUTRAL] OK, yeah, none has been used so far this year.
[AGENT][NEUTRAL] If you would give me just a moment, um, [PII], I'm gonna put you on a brief hold and just get clarification that uh specialist office would be fall under the same category as the physician's office benefit.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK.
[AGENT][POSITIVE] Alright thank you I'll be right back with you.
[CUSTOMER][POSITIVE] Thank you, OK.
[CUSTOMER][NEGATIVE] You are on hold.
[CUSTOMER][NEUTRAL] Currently no agents staffed. Goodbye.
[AGENT][NEUTRAL] Oh.
[AGENT][NEUTRAL] What?
[AGENT][NEUTRAL] Oh.
[AGENT][NEUTRAL] There we go.