AccountId: 011433970860
ContactId: 566b77b7-cd2e-42e8-acf9-35afccf3437b
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 434049 ms
Total Talk Time (AGENT): 127101 ms
Total Talk Time (CUSTOMER): 216876 ms
Interruptions: 4
Overall Sentiment: AGENT=0.1, CUSTOMER=0.6
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/02/21/566b77b7-cd2e-42e8-acf9-35afccf3437b_20250221T20:23_UTC.wav
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[AGENT][NEUTRAL] Thank you for calling APL. This is [PII]. How can I help you?
[CUSTOMER][NEUTRAL] Hi, hi, this is [PII] calling from provider's office.
[AGENT][NEUTRAL] [PII], how are you?
[CUSTOMER][POSITIVE] Yeah, sorry, uh yeah, I'm fine thank you for asking. How are you too?
[AGENT][POSITIVE] Doing well thank you. What can we do for you today?
[CUSTOMER][NEUTRAL] I just want to verify the eligibility status and also I need to know that if, if this plan is uh secondary for this member, that's all.
[AGENT][NEUTRAL] Sure, I could check that eligibility and plan type for you. Uh, [PII], can I get a good call back number from you first in case we're disconnected?
[CUSTOMER][NEUTRAL] Mm
[CUSTOMER][NEUTRAL] Um
[CUSTOMER][NEUTRAL] Yeah, uh it's uh 941.
[CUSTOMER][NEUTRAL] 312
[CUSTOMER][NEUTRAL] 2851.
[AGENT][NEUTRAL] Thank you. Do you have the policy number?
[CUSTOMER][NEUTRAL] Oh yeah, yeah. Uh it's 018.
[CUSTOMER][NEUTRAL] 291
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] 00
[CUSTOMER][NEUTRAL] M as in Mike. L as Lima, 8.
[AGENT][NEUTRAL] Thank you and then what was the name and date of birth for the insured?
[CUSTOMER][NEUTRAL] It's uh [PII].
[CUSTOMER][NEUTRAL] And the date of birth is [PII].
[AGENT][NEUTRAL] OK, thank you for verifying that [PII]. So this policy is active. Effective date was [PII], and yes, this is a secondary medical policy, so it is designed to help with co-pay, deductible and co-insurance after major medical pays.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Hm.
[CUSTOMER][NEUTRAL] Mm.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] OK. Uh, and I just want to know that is this plan have any uh term date?
[AGENT][NEUTRAL] No, it is currently active.
[CUSTOMER][NEUTRAL] OK. Uh, and, uh, OK. One second. Uh, I need the benefits for specialist office visit. Uh, I think, mhm, yeah.
[AGENT][NEUTRAL] OK, give me just a moment, let me see if that's covered under this policy.
[CUSTOMER][NEUTRAL] Yeah, OK.
[AGENT][NEUTRAL] And of course I will let you know verification of coverage is not a guarantee of payment for claims. Uh, so office visits are not covered under this policy. However, treatment received in office could be, that would go under their outpatient benefit, which is on a per calendar day basis. It pays up to $500 per calendar day.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] OK. OK. Once again, hold on, please.
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Yeah. Thank you, thank you. Um, yeah, uh, OK. Uh, I read that, uh, the plans cover the primary leftover in full after, uh, $500 copay per day, right?
[AGENT][NEUTRAL] No, um, so the benefit amount is $500 max per calendar day.
[AGENT][NEUTRAL] That's the maximum benefit amount that we would pay.
[CUSTOMER][NEUTRAL] A
[CUSTOMER][NEUTRAL] Oh, the
[CUSTOMER][NEUTRAL] Uh, that's the next moment. OK, one second please hold on.
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Uh, um, uh, the patient needs to pay $500 copy, right?
[AGENT][NEUTRAL] No, that's the benefit amount we would pay. That is their benefit amount for this policy.
[CUSTOMER][NEUTRAL] 426.
[CUSTOMER][NEUTRAL] Oh, OK. Oh.
[CUSTOMER][NEUTRAL] Oh, OK, OK, OK. One second, please hold. I'm sorry for this inconvenience.
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Oh, OK. Uh, you said that the patient, um, uh, uh, treatment is, uh, covered by a secondary. It's a maximum is 500 only, right?
[AGENT][NEUTRAL] Their maximum outpatient benefit is $500 per calendar day.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Oh, then there is no, uh, co-pay for this patient.
[AGENT][NEUTRAL] Not for this plan, no. This is the secondary medical.
[AGENT][POSITIVE] It helps, it's designed to help with co-pay, deductible and co-insurance from major medical.
[CUSTOMER][NEUTRAL] OK. Uh, the
[CUSTOMER][NEUTRAL] OK. OK. Uh, then the patient, uh, there is no need to pay any, any kind of, uh, uh, amount, right? OK. Because
[AGENT][NEGATIVE] Not for this policy. This policy doesn't have a deductible or co-pay.
[CUSTOMER][NEUTRAL] OK. Uh, the, the patient only uh the, the policy only covers, uh, uh, the benefits amount is maximum 500, right? OK.
[AGENT][NEUTRAL] Per calendar day, correct.
[CUSTOMER][NEUTRAL] The calendar. 00, OK. The calendars, uh.
[CUSTOMER][NEUTRAL] Per day, right?
[AGENT][NEUTRAL] Yes.
[CUSTOMER][NEUTRAL] Uh, OK, OK.
[CUSTOMER][POSITIVE] OK, thank you.
[AGENT][NEUTRAL] Mhm, did you have any other questions for me?
[CUSTOMER][NEUTRAL] Mm
[CUSTOMER][NEUTRAL] Oh, that's all, that's all. There is no any other questions. And, and I just want to know your name. Uh, can you please spell out that?
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] Yeah, it's [PII].
[CUSTOMER][NEUTRAL] [PII]
[AGENT][NEUTRAL] Yes.
[CUSTOMER][NEUTRAL] [PII], yeah. And your last name sir?
[AGENT][NEUTRAL] Mhm.
[AGENT][NEUTRAL] A
[CUSTOMER][NEUTRAL] Oh, OK.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Uh, and the, uh, call reference number is, uh, today's date, right?
[AGENT][NEUTRAL] Uh, my first name, last initial, and today's date, yes.
[CUSTOMER][POSITIVE] OK, OK, thank you, thank you.
[AGENT][NEUTRAL] Of course.
[CUSTOMER][POSITIVE] Thank you
[CUSTOMER][NEUTRAL] Because uh previous time I called on rep, uh because uh we misunderstood that this patient need to pay $100 as a that's why uh the.
[AGENT][NEUTRAL] Oh.
[AGENT][NEGATIVE] Oh, it is a bit confusing. That's an easy mistake to make.
[CUSTOMER][POSITIVE] OK, thank you. Thank you, thank you.
[AGENT][NEUTRAL] Of course. Was there anything else I can help you with, sir?
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] That's all, that's all. There is no any other questions, mhm.
[AGENT][POSITIVE] Alright well thanks for giving us a call. I hope you have a great rest of your day.
[CUSTOMER][POSITIVE] Mm thank you. You too, bye. Have a nice day.
[AGENT][NEUTRAL] Bye-bye.
[AGENT][NEUTRAL] You too.
[CUSTOMER][NEUTRAL] Bye bye.