AccountId: 011433970860
ContactId: 55540b82-eaef-4dfd-9eeb-d6e812776669
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 385369 ms
Total Talk Time (AGENT): 127608 ms
Total Talk Time (CUSTOMER): 113624 ms
Interruptions: 4
Overall Sentiment: AGENT=0.5, CUSTOMER=-0.3
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/02/05/55540b82-eaef-4dfd-9eeb-d6e812776669_20250205T19:40_UTC.wav
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[AGENT][NEUTRAL] Calling APL. This is [PII]. How may I assist you?
[CUSTOMER][NEUTRAL] Hi, my name is [PII]. I'm actually calling from Anchored Wellness and Recovery. I'm calling about a client that we have, uh, that presented his insurance card, and we're trying to find out if he has a copay and exactly what his insurance insurance will cover at our facility.
[AGENT][NEUTRAL] And what was your name?
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] [PII]?
[CUSTOMER][NEUTRAL] [PII]
[AGENT][NEUTRAL] Thank you, [PII]. Can I have a callback number for you and that policy number?
[CUSTOMER][NEUTRAL] Um, callback number is [PII].
[CUSTOMER][NEUTRAL] And the policy number is 025742229.
[AGENT][NEUTRAL] Could you verify the patient's name and date of birth?
[CUSTOMER][NEUTRAL] Yes, [PII], his birthday is [PII].
[AGENT][NEUTRAL] And you're calling to verify if the member has a co-pay for office visits?
[CUSTOMER][NEUTRAL] Yes, and to see if like for his office visits if like what how much it will cover because we're, we're like um.
[CUSTOMER][NEUTRAL] He gets like Suboxone.
[AGENT][NEUTRAL] Thank you. So I'm gonna have to transfer you to the queue, the correct queue for them to better assist you. May I place you on a brief hold?
[CUSTOMER][NEUTRAL] Sure.
[AGENT][NEUTRAL] Mhm
[AGENT][NEUTRAL] Verify [PII]'s date of birth again for me if you don't mind, [PII].
[CUSTOMER][NEUTRAL] [PII].
[AGENT][POSITIVE] Thank you. Hold one moment.
[CUSTOMER][NEGATIVE] You are on hold.
[CUSTOMER][NEUTRAL] Transferring.
[CUSTOMER][NEGATIVE] You are on hold.
[AGENT][NEUTRAL] Thank you for holding, [PII]. So I didn't get anyone in the queue for the HR department, the correct queue, however, just to read off the benefits, the member has $125.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] For office visit?
[AGENT][NEUTRAL] No.
[CUSTOMER][NEUTRAL] That's how much he has to, but he has to pay.
[AGENT][NEUTRAL] No, actually, this is his benefit when.
[AGENT][NEUTRAL] It's $50 per visit with 5 visits per calendar year, and this is not a guaranteed benefit just a disclaimer.
[CUSTOMER][NEUTRAL] OK, $50 I'm sorry, I'm, hold on, I'm writing this down $50 per visit and then he can have how many per year?
[AGENT][NEUTRAL] 5 visits per calendar year and this is not a guaranteed benefits just a disclaimer of the policy.
[CUSTOMER][NEUTRAL] I visit calendar.
[CUSTOMER][NEUTRAL] 0 $50 per visit and then he can have 5 visits per calendar year.
[AGENT][POSITIVE] Yes, that is correct.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] Is there anything else that I can assist you with?
[CUSTOMER][NEUTRAL] Is there
[CUSTOMER][NEUTRAL] Is there any way that you can send, do you have a paper that you can fax to me that has that on there?
[AGENT][NEUTRAL] No, ma'am, we don't, we can't fax it over for you.
[CUSTOMER][NEUTRAL] OK, then I will let him know that.
[AGENT][NEUTRAL] All right. Is there anything else that I can assist you with today?
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] No, thank you. Now, uh, wait a minute. I have a question. So claims, hello?
[AGENT][POSITIVE] Thanks for calling.
[AGENT][NEUTRAL] Yes, I'm here.
[CUSTOMER][NEUTRAL] Oh OK, sorry, I had somebody else was talking in the office, so if we submit claims, how much of it will actually be paid?
[AGENT][NEUTRAL] See, I don't work in that queue, so what I'm saying is it's, it's $50 per visit, so we will pay up to $50.
[CUSTOMER][NEUTRAL] Like from our facility because
[CUSTOMER][NEUTRAL] OK, but if he was to get prescriptions and stuff.
[AGENT][NEUTRAL] That's not his deductible or copay. I'm not sure because I don't deal with prescription. That's a different company.
[CUSTOMER][NEUTRAL] OK, well, we're trying to figure out like is it I mean.
[AGENT][NEUTRAL] Let me see if somebody's available. I, I.
[AGENT][NEUTRAL] Go ahead.
[CUSTOMER][NEUTRAL] I was trying to find out like how much of like.
[AGENT][NEUTRAL] Let me see if someone is available.
[AGENT][NEUTRAL] So you can be able to get your questions answered because I don't want you to leave the phone confused because I'm confused, just as confused as you is and I'm just reading the policy.
[AGENT][NEUTRAL] So hold one moment, OK?
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] All right. You are on hold.
[AGENT][NEUTRAL] Just hold on I'm here with this.
[CUSTOMER][NEUTRAL] Ferring.
[AGENT][NEUTRAL] Hello, [PII], unfortunately, there's still no one available in that queue.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] But the office visit is $50 per visit. However, there should be a, uh, on the back of his card, if he has the card, there should be information in regards to where he can contact in regards to his prescriptions.
[CUSTOMER][NEUTRAL] Well, I will try to call.
[CUSTOMER][NEUTRAL] There's a pharmaceutical or pharma availability thing that's on the back of his card. I guess he'll just have to call that and see how much it will actually cover.
[AGENT][NEUTRAL] Cause it's
[AGENT][NEUTRAL] Yes.
[AGENT][NEUTRAL] That's for his pharmaceutical, yes.
[CUSTOMER][NEUTRAL] OK, well I will do that then.
[AGENT][POSITIVE] Thank you for calling APL and you have a great day.
[CUSTOMER][NEUTRAL] If
[AGENT][NEUTRAL] Bye.