AccountId: 011433970860
ContactId: 5602cd47-d405-403e-8251-32bba33f0047
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 264070 ms
Total Talk Time (AGENT): 134832 ms
Total Talk Time (CUSTOMER): 101369 ms
Interruptions: 1
Overall Sentiment: AGENT=0.2, CUSTOMER=0.5
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/06/09/5602cd47-d405-403e-8251-32bba33f0047_20250609T17:22_UTC.wav
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[AGENT][NEUTRAL] Thank you for calling APL. This is [PII]. How can I help you?
[CUSTOMER][NEUTRAL] Hello, good afternoon. I'm calling from my doctor's office to verify benefits for a patient, please.
[AGENT][POSITIVE] Yeah, I can check benefits for you. Uh, what was your name please?
[CUSTOMER][NEUTRAL] My name is [PII].
[AGENT][NEUTRAL] OK, uh, [PII], can I get a good call back number from you in case we're disconnected please?
[CUSTOMER][NEUTRAL] Yes, it is [PII].
[AGENT][NEUTRAL] OK, thank you. And then do you have that policy number?
[CUSTOMER][NEUTRAL] Yes, I have the policy as 01066917.
[AGENT][NEUTRAL] OK and then what was the name and date of birth for the member please?
[CUSTOMER][NEUTRAL] Yes, the number is [PII], [PII].
[AGENT][NEUTRAL] Perfect, thank you for verifying that. Uh, so this policy is active, uh, effective date was [PII], and this is a secondary medical policy, so it is designed to help with co-pay, deductible and co-insurance after major medical pays, and we're needing to look at, uh, inpatient or outpatient benefits for this member.
[CUSTOMER][NEUTRAL] Outpatient, please.
[AGENT][NEUTRAL] OK, and of course I will let you know verification of coverage is not a guarantee of payment for claims, so that outpatient benefit pays on a per occurrence basis and so that would be $500 per occurrence.
[CUSTOMER][NEUTRAL] Oh, OK. Um, sorry, let me repeat that. So, you said this is a secondary insurance, right?
[AGENT][NEUTRAL] Sure.
[AGENT][NEUTRAL] Yes.
[CUSTOMER][NEUTRAL] OK. And this will pick up any uh co-payment or co-insurance after the deductible from the primary pay. Is that correct?
[AGENT][NEUTRAL] Uh
[AGENT][NEUTRAL] So the benefit amount that we pay uh goes towards co-pay, deductible and co-insurance after major medical pays. So this plan is very dependent on major medical as long as they're willing to pay this policy helps with all of that.
[CUSTOMER][NEUTRAL] OK, so the primary pays and you guys pay um uh whatever the patient was responsible for. Is that correct? I'm sorry.
[AGENT][NEUTRAL] Correct, yes, um, so for outpatient services that uh that would pay up to $500 towards co-pay, deductible and co-insurance per occurrence.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Got it.
[CUSTOMER][NEUTRAL] Occurrence meaning date of service, right?
[AGENT][NEUTRAL] No, uh, so this one is going to be a bit different. Um, occurrence would be, um, you know, for example, if somebody had broken their wrist, um, so anything regarded that is going to be one occurrence, um, so that's gonna be $500 for that if they, you know, sprain their ankle after that, then that's going to be a separate $500.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Mm.
[CUSTOMER][NEUTRAL] Mhm. OK. So this is an allergist office, so meaning only one claim, like fishing and gas allergy shot.
[CUSTOMER][NEUTRAL] So up to 500 for the complete allergy.
[AGENT][NEUTRAL] That would be its own, anything like that.
[AGENT][NEUTRAL] Right, yeah.
[CUSTOMER][NEUTRAL] Mhm. OK, good. And is there any, uh, out of pocket that's maximum or not?
[AGENT][NEGATIVE] Not for this plan, no, there's no deductible or anything like that for this one.
[CUSTOMER][NEUTRAL] Only the 500 currencies.
[AGENT][NEUTRAL] Uh, that's the benefit amount that we would pay, yes.
[CUSTOMER][NEUTRAL] Occurrence.
[CUSTOMER][NEUTRAL] OK. Good. Uh, and then what will be the, um, the payer ID for this insurance?
[AGENT][NEUTRAL] Right, that is uh 60801.
[CUSTOMER][NEUTRAL] Oh, I'm sorry. Can you repeat that again? 60.
[AGENT][NEUTRAL] That's OK. 60801.
[CUSTOMER][NEUTRAL] OK, so that will be the electronic pay ID, right?
[AGENT][NEUTRAL] Yes.
[CUSTOMER][NEUTRAL] OK, OK.
[CUSTOMER][POSITIVE] Thank you very much. Can I have a reference number for your, for your call, please?
[AGENT][NEUTRAL] Sure.
[AGENT][NEUTRAL] A reference number would just be my first name, last initial, and today's date. Uh so my name is spelled [PII] Was there anything else I could help you with?
[CUSTOMER][POSITIVE] That's all. Thank you very much. Have a nice day.
[AGENT][POSITIVE] Of course, thanks for calling APO you too bye bye.
[CUSTOMER][NEUTRAL] My