AccountId: 011433970860
ContactId: 57edd496-5539-4ba9-a74a-79153dedc6b5
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 201639 ms
Total Talk Time (AGENT): 71759 ms
Total Talk Time (CUSTOMER): 83026 ms
Interruptions: 0
Overall Sentiment: AGENT=0.5, CUSTOMER=1.2
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/06/19/57edd496-5539-4ba9-a74a-79153dedc6b5_20250619T16:25_UTC.wav
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[AGENT][NEUTRAL] Thank you for calling American Public Life. This is [PII]. How may I assist you?
[CUSTOMER][NEUTRAL] Hello, my name is [PII], and I'm calling from Agen Support Plus on a recorded line at the request of Doctor [PII] to verify eligibility and benefits for a patient named [PII] with a date of birth of [PII].
[AGENT][NEUTRAL] May I have a callback number?
[CUSTOMER][NEUTRAL] Yes, it is [PII].
[AGENT][NEUTRAL] And may I have the policy number?
[CUSTOMER][NEUTRAL] 01423563
[AGENT][NEUTRAL] And you're calling in for eligibility and benefits, is there a specific benefit that you're calling in for?
[CUSTOMER][NEUTRAL] I show that this policy is secondary to Medicare, and is this a Medicare supplement plan?
[AGENT][NEUTRAL] This is just a gap supplement. It's not a Medicare or any of that.
[CUSTOMER][NEUTRAL] A gap supplement. And do you follow Medicare guidelines?
[AGENT][NEUTRAL] What do you mean, do we follow Medicare guidelines? It's based off of our policy.
[CUSTOMER][NEUTRAL] OK, and do you show this policy to be active and what is the effective date?
[AGENT][NEUTRAL] It does show that the policy is currently active with the effective date of [PII].
[CUSTOMER][NEUTRAL] [PII].
[CUSTOMER][NEUTRAL] And I'm calling to verify in network benefits for an injection of Pavlue done in a doctor's office, and I have two codes. The first one is Q5147. The admin code is 67028. The diagnosis code is H35.3231.
[AGENT][NEUTRAL] OK, so for this policy, we don't go off of off of the procedure codes, we just verify if it's in the office, inpatient or outpatient. So you're calling in for office procedure benefits in regards to this policy, verification of coverage does not guarantee the payment of the claim. This member does not have the office visit fee or office procedure benefit rider. Is there anything else that I can assist you with today, [PII]?
[CUSTOMER][NEUTRAL] So they don't have an office visit writer, so these codes would not be covered correct because this will be done in a specialist office.
[AGENT][NEUTRAL] Correct. They do not have the office fee or office procedure benefit writer.
[CUSTOMER][NEUTRAL] No office visit writer, OK, and can I get the first letter of your last name and a call reference number?
[AGENT][NEUTRAL] The car reference would be my first name [PII], which is spelled [PII] last initial of [PII] and today's date.
[CUSTOMER][POSITIVE] OK, thank you so much. I hope you have a great rest of your day.
[AGENT][POSITIVE] You're welcome and thank you for calling American Public Life [PII], you have a great day as well.
[CUSTOMER][POSITIVE] Thank you bye bye.