AccountId: 011433970860
ContactId: 5d693179-1ec6-441a-96b4-3f3574e1bd09
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 321480 ms
Total Talk Time (AGENT): 116856 ms
Total Talk Time (CUSTOMER): 105732 ms
Interruptions: 0
Overall Sentiment: AGENT=0.4, CUSTOMER=0.1
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/03/10/5d693179-1ec6-441a-96b4-3f3574e1bd09_20250310T12:01_UTC.wav
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[AGENT][NEUTRAL] Thank you for calling APL. This is [PII]. How may I help you?
[CUSTOMER][NEUTRAL] Yes, hi, good morning. My name is [PII]. I'm calling from Vital MD Group Holdings, and I'm calling because I need to get benefits and eligibility for 2 members, please.
[AGENT][NEUTRAL] I can help you [PII], do you have the policy numbers?
[CUSTOMER][NEUTRAL] Yes, the first one is 02073996 ML 8.
[AGENT][NEUTRAL] What's a good phone number in case we're disconnected?
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] OK, and what's the other policy number?
[CUSTOMER][NEUTRAL] The other policy number is let me go to that one.
[CUSTOMER][NEUTRAL] OK, the second one is 01740494ML8.
[AGENT][POSITIVE] Thank you one moment let me pull up the file and then we can assist you with the information.
[CUSTOMER][POSITIVE] Alright thank you.
[AGENT][NEUTRAL] So for the first policy 020739996, what's the patient's name and date of birth?
[CUSTOMER][NEUTRAL] It's [PII] and her date of birth is [PII].
[AGENT][NEUTRAL] OK, and you're just checking eligibility?
[CUSTOMER][NEUTRAL] Yeah, eligibility and benefits, um, I'm calling from an OBGYN office.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] So the current policy number is 225.
[AGENT][NEUTRAL] 27
[CUSTOMER][NEUTRAL] Oh this is a different, I'm sorry, it's a different ID number, member ID number?
[AGENT][NEUTRAL] The policy number you gave me is no longer active, so I'm giving you the current policy number.
[CUSTOMER][NEUTRAL] Oh
[CUSTOMER][NEUTRAL] Oh, OK, um, so what is that one?
[AGENT][NEUTRAL] 225-278-9.
[AGENT][NEUTRAL] Showing the policy effective date of [PII], the policy is active. One moment.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Mhm, uh huh.
[AGENT][NEUTRAL] Uh, the office visit fee is not covered, but there is a treatment rider. So if there's covered treatment performed in the office, those items can be considered under the outpatient benefit. Did you want that benefit?
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Uh
[CUSTOMER][NEUTRAL] Yeah, please.
[AGENT][NEUTRAL] That's up to $7350. That is a per calendar year benefit, and any information provided today is verification. It doesn't guarantee payment of a claim, and at this time I'm not showing any of that benefit used this year. And did you have any other questions on that one?
[CUSTOMER][NEUTRAL] Uh huh.
[CUSTOMER][NEUTRAL] OK
[CUSTOMER][NEGATIVE] No, no, not for this one, no.
[AGENT][NEUTRAL] OK, sure, let's move to the other one, give me one moment.
[CUSTOMER][NEUTRAL] Sure.
[AGENT][NEUTRAL] And what's the patient's name and date of birth for policy number 174-0494?
[CUSTOMER][NEUTRAL] OK, this is also a different one now 174174.
[AGENT][NEUTRAL] Uh-huh.
[AGENT][NEUTRAL] The policy number that you gave me, 0174.
[CUSTOMER][NEUTRAL] Uh
[CUSTOMER][NEUTRAL] Oh, it is supposed
[AGENT][NEUTRAL] 0494.
[CUSTOMER][NEUTRAL] Uh huh
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] All right, so this is [PII] and her date of birth is [PII].
[AGENT][NEUTRAL] OK, thank you. The effective date is [PII].
[CUSTOMER][NEUTRAL] OK, and then the same benefits um for in office.
[AGENT][NEUTRAL] I'm showing that the policy is currently active at this time.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] And the physician visit fee and then treatment in the office is not covered under this particular policy.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] Any other questions?
[CUSTOMER][NEUTRAL] So nothing in the office is covered?
[AGENT][NEUTRAL] A physician visit fee nor treatment in the office is covered under this policy.
[CUSTOMER][NEUTRAL] OK
[CUSTOMER][NEUTRAL] So that means the ultrasounds aren't covered in office surgical procedures aren't covered as well, correct?
[AGENT][NEUTRAL] And treatment in the office is not covered. Any treatment is not covered.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Alright and then um let me see, is there a reference number I could get?
[AGENT][NEUTRAL] My name and today's date, [PII].
[CUSTOMER][POSITIVE] OK perfect thank you very much for your help I appreciate it.
[AGENT][POSITIVE] You're welcome thanks for calling APL have a good day.
[CUSTOMER][NEUTRAL] You too bye bye.