AccountId: 011433970860
ContactId: 551b088c-7c78-4c21-8b5c-5fe19356478f
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 257190 ms
Total Talk Time (AGENT): 113700 ms
Total Talk Time (CUSTOMER): 89771 ms
Interruptions: 1
Overall Sentiment: AGENT=0.3, CUSTOMER=0.7
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/05/27/551b088c-7c78-4c21-8b5c-5fe19356478f_20250527T19:01_UTC.wav
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[AGENT][NEUTRAL] Thank you for calling American Public Life. [PII], how may I help you?
[CUSTOMER][NEUTRAL] Good afternoon [PII]. I'm calling for Bene please.
[AGENT][NEUTRAL] I can verify benefits. May I have your name and the policy number?
[CUSTOMER][NEUTRAL] It's [PII], [PII].
[AGENT][NEUTRAL] [PII], may I have a good callback number for you?
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] Thank you. May I have the patient's name and date of birth?
[CUSTOMER][NEUTRAL] It is [PII]. I don't know how to pronounce the last name. It's [PII].
[AGENT][NEUTRAL] And date of birth?
[CUSTOMER][NEUTRAL] It is [PII].
[AGENT][NEUTRAL] Thank you for verifying that information. Please be advised that verification of coverage does not guarantee the payment of a claim. And which benefit can I provide for you?
[CUSTOMER][NEUTRAL] Is the coverage for inpatient and outpatient um ultrasounds, procedure, maternity?
[AGENT][NEUTRAL] OK. So for inpatient per occurrence, it allows $5000.
[AGENT][NEUTRAL] For outpatient per occurrence, it allows $500.
[CUSTOMER][NEUTRAL] OK, that will be per year, per day.
[AGENT][NEUTRAL] It's per occurrence, which means per condition.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] The patient, um, she's here for an ultrasound. That will be covered on the $500.
[AGENT][NEUTRAL] Is this an office visit or is this an outpatient surgical center, outpatient hospital?
[CUSTOMER][NEUTRAL] No, this is an office, but she's having a um ultrasound.
[AGENT][NEUTRAL] OK, so let me get that pulled up for the physician's office.
[AGENT][NEUTRAL] One moment.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] Let's see, so that would allow $25 per visit for physician's office.
[CUSTOMER][NEUTRAL] But the um the primary insurance, the ultrasound is gonna be under the deductible. You guys don't cover the deductible for the primary?
[AGENT][NEUTRAL] It will pick up the copays, the co-insurance and or deductibles, but for the physician's visit, the physician's office treatment, it only allows $25 per visit with a max of 4 visits per calendar year.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Yeah, that I know, but um, I, that's why I was asking for the ultrasound because she's not here for a visit.
[AGENT][MIXED] Correct, but it's performed.
[CUSTOMER][NEUTRAL] So that uh my question is is mhm.
[AGENT][NEUTRAL] It's the place of service that the ultrasound is being rendered. If the ultrasound sound was in um outpatient facility or freestanding facility or diagnostic testing, then it would fall under the 500 per occurrence. But since the place of service is an office.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Got it.
[CUSTOMER][NEUTRAL] Got it, got it. OK. And can I get a reference number please and your name?
[AGENT][NEUTRAL] Yes, the reference will be my name, which is [PII] Last initial is [PII] along with today's date. [PII], is there anything else I can assist you with?
[CUSTOMER][POSITIVE] No, Ms. [PII] thank you have a wonderful day.
[AGENT][POSITIVE] Thank you for calling American Public Life, [PII]. Have a great day. Bye-bye.
[CUSTOMER][POSITIVE] You too thank you bye bye.