AccountId: 011433970860
ContactId: 56b24f58-46a5-4c78-97e1-92962f68a58a
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 193630 ms
Total Talk Time (AGENT): 112209 ms
Total Talk Time (CUSTOMER): 71400 ms
Interruptions: 1
Overall Sentiment: AGENT=2.7, CUSTOMER=0.9
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/04/01/56b24f58-46a5-4c78-97e1-92962f68a58a_20250401T13:21_UTC.wav
--------------------------------------------
[AGENT][POSITIVE] And thank you for calling APL. This is. How may I help you today?
[CUSTOMER][NEUTRAL] Hi, I'm calling uh for benefits for a patient that's coming in for a specialist office visit as well as an ultrasound being done in the office.
[AGENT][POSITIVE] OK, I'll be glad to help you. Go and give me your name and the member's policy number.
[CUSTOMER][NEUTRAL] My name is [PII], uh, policy number 01482796ML8.
[AGENT][POSITIVE] Alrighty, [PII], thank you so much for that information. Now while I'm pulling this up, go ahead and give me a good return telephone call number, please.
[CUSTOMER][NEUTRAL] It is [PII].
[AGENT][POSITIVE] Alrighty, thank you so much, [PII], for all that information. Now, your patient's name and date of birth today, please, ma'am.
[CUSTOMER][NEUTRAL] Is [PII] [PII].
[AGENT][NEUTRAL] Alrighty, thank you so much, [PII], for all that information. Looks like [PII] is a dependent on this medical supplemental plan. I do show the original effective date is [PII]. Patient is currently active, but I must advise that verification of coverage is not a guarantee of payment on the claim, but you did say you want benefits for office visit and something done in the office, correct?
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Yeah, an ultrasound.
[AGENT][NEUTRAL] OK, let me get that benefit pack pulled up. OK, let's see. Now, what we, of course, is the medical supplemental plan. So the only thing that we will pick up and pay on is anything that is applied towards her deductible, co-pay, or co-insurance for sickness and injury at her primary insurance carrier. Now her benefits here, she don't have an office visit charge benefit.
[AGENT][NEUTRAL] But anything done in the office um would have a benefit here and it's a no pre-cert and they have $500 payable per calendar day benefit here.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] $500. OK. OK. So, correct me if I'm wrong, just to make sure I got it. So you guys will cover the um the ultrasound being done in the office, but it doesn't sound like it covers the office visit.
[AGENT][NEUTRAL] Mhm.
[AGENT][NEUTRAL] Yes, ma'am.
[AGENT][POSITIVE] Correct.
[CUSTOMER][NEUTRAL] Because there is a copay for for both due to her primary.
[AGENT][NEUTRAL] No, ma'am, yeah, we, we will not cover the office visit copay at all.
[CUSTOMER][NEUTRAL] So
[CUSTOMER][NEUTRAL] OK, OK, that's fine, just the ultrasound copay.
[AGENT][NEUTRAL] Mhm. Mhm. Yes, ma'am. Is that all I can help you with today, [PII]? Mhm.
[CUSTOMER][NEUTRAL] Yeah, OK, per day.
[CUSTOMER][NEUTRAL] Yes ma'am, that's all uh what was your name again? I'm sorry.
[AGENT][NEUTRAL] That's OK. My name is [PII] and that is spelled [PII]
[CUSTOMER][NEUTRAL] OK, any reference number for the call?
[AGENT][NEUTRAL] No, [PII], we don't give reference numbers, but you can use my name in today's date and is that all I can answer for you today?
[CUSTOMER][POSITIVE] Uh, yeah, I think so. Thank you so much for your help.
[AGENT][NEUTRAL] OK.
[AGENT][POSITIVE] Oh yes, ma'am, [PII], and thanks for calling APO. You have a great rest of your day, OK?
[CUSTOMER][POSITIVE] Alrighty bye bye.