AccountId: 011433970860
ContactId: 5e301efc-91d5-4719-ada5-d922c81fe10e
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 284109 ms
Total Talk Time (AGENT): 95165 ms
Total Talk Time (CUSTOMER): 84950 ms
Interruptions: 1
Overall Sentiment: AGENT=0.2, CUSTOMER=0.6
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/05/05/5e301efc-91d5-4719-ada5-d922c81fe10e_20250505T16:04_UTC.wav
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[AGENT][NEUTRAL] Thank you for calling APL. This is [PII]. How can I help you?
[CUSTOMER][NEUTRAL] Hi, good, good morning. Oh, sorry, um, I'm calling from the orthopedic Center in [PII]. My name is [PII]. My last initial is age. I was just calling because I have a patient coming in, um, in about a week, and I was just calling for an insurance verification to ask if the secondary will cover, um.
[CUSTOMER][NEUTRAL] Her first, her primary?
[AGENT][NEUTRAL] OK. Uh, do you have a good callback number, [PII]?
[CUSTOMER][NEUTRAL] Yes, it is [PII].
[AGENT][NEUTRAL] OK, and you're needing benefits and eligibility?
[CUSTOMER][NEUTRAL] Yes.
[AGENT][NEUTRAL] OK. Do you have the policy number of the patient?
[CUSTOMER][POSITIVE] Yes, I do.
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] It is 1484324.
[AGENT][NEUTRAL] Patient name and date of birth?
[CUSTOMER][NEUTRAL] Um, [PII]. Uh, date of birth is [PII].
[AGENT][NEUTRAL] OK, looks like this policy terminated in [PII]. Let me see if there is an active policy.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] OK, looks like there's an active policy. Let me give you that number.
[AGENT][NEUTRAL] Um, it is 212-355-0.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] And that one's an active and effective [PII].
[AGENT][NEUTRAL] And is this for outpatient benefits?
[CUSTOMER][NEUTRAL] Yes, in office for physical therapy.
[AGENT][NEUTRAL] I guarantee a payment, basic outline of the policy.
[AGENT][NEUTRAL] Um, let me see what those are.
[AGENT][NEUTRAL] OK, so they have a 6650 per covered person per calendar year maximum benefit payable.
[AGENT][NEUTRAL] Um, outpatient services are
[CUSTOMER][NEUTRAL] I'm sorry, can you repeat that?
[AGENT][NEUTRAL] 6650.
[AGENT][NEUTRAL] Calendar your maximum benefit payable.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] There is a $500 deductible.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] And then that's gonna be for treatment and procedures rendered in office. So if you bill for an actual office visit, the office visits not covered, but treatment and procedures rendered in the office are covered.
[CUSTOMER][NEUTRAL] OK, so sorry, give me one second.
[CUSTOMER][NEUTRAL] So, this patient, he has a primary, and he, when he called, he said that the secondary will be able to cover the visits, so he wouldn't have to pay.
[CUSTOMER][NEUTRAL] But like you said, um, the office visits aren't covered, but the treatments are.
[AGENT][NEUTRAL] Right.
[CUSTOMER][NEUTRAL] Um, the treatments come with the office visits.
[AGENT][NEUTRAL] Subject to a 500.
[AGENT][NEUTRAL] OK, yeah, so the, the plan doesn't cover office visits, but it will cover any treatment or procedures rendered in office, subject to a $500 calendar year deductible, and then the maximum payable is $6650.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] 7
[CUSTOMER][POSITIVE] Alrighty thank you so much. Can I please just have a reference number for this call?
[AGENT][NEUTRAL] A reference number is my name, [PII]. First initial to last name is [PII] as [PII].
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] And today's date. And anything else I can help with, [PII]?
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][POSITIVE] No, thank you so much for all your help.
[AGENT][POSITIVE] Thank you for calling APL. I hope you have a good day.
[CUSTOMER][NEUTRAL] You as well bye bye.