AccountId: 011433970860
ContactId: 6171358d-52dc-4f3d-b5fd-b45a1fac7c67
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 283959 ms
Total Talk Time (AGENT): 143476 ms
Total Talk Time (CUSTOMER): 78927 ms
Interruptions: 1
Overall Sentiment: AGENT=1, CUSTOMER=1.4
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/03/10/6171358d-52dc-4f3d-b5fd-b45a1fac7c67_20250310T17:52_UTC.wav
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[AGENT][POSITIVE] Good afternoon. Thank you for calling APL. My name is [PII]. How may I help you?
[CUSTOMER][NEUTRAL] Hi [PII], my name is [PII] calling from Gemini OBGYN on benefits on a member, please.
[AGENT][POSITIVE] OK, I can definitely help you with the benefits. And may I have a good contact number in case we're disconnected?
[CUSTOMER][NEUTRAL] [PII]
[AGENT][NEUTRAL] Thank you for that. And may I have the member's policy number?
[CUSTOMER][NEUTRAL] 02497662 M as in Mary L as in Lima 8
[AGENT][POSITIVE] Thank you. Hold on one moment.
[CUSTOMER][NEUTRAL] Mhm
[AGENT][NEUTRAL] And can you verify the member's first and last name and date of birth?
[CUSTOMER][NEUTRAL] [PII] [PII].
[AGENT][NEUTRAL] Thank you for that and all the information provided is a verification of benefits, not a guarantee of payment. And I am showing that the policy is active. It's been effective since [PII]. And what type of benefits did you want to go over today?
[CUSTOMER][NEUTRAL] Global maternity.
[AGENT][NEUTRAL] OK, hold on one moment.
[CUSTOMER][POSITIVE] You got it.
[AGENT][NEUTRAL] I'm just waiting for the benefits to pop up here.
[AGENT][NEUTRAL] So,
[AGENT][NEUTRAL] So the the policy is broken down into like inpatient and outpatient. So, are you wanting like visit appointments or inpatient? OK.
[CUSTOMER][POSITIVE] Correct.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Inpatient
[CUSTOMER][POSITIVE] Well, we build globally for maternity so I mean I I'll take both inpatient and outpatient benefits we'll just see what she has.
[AGENT][NEUTRAL] Hold on.
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] But it would cover pregnancy if it's the policy does not exclude pregnancy, correct?
[AGENT][POSITIVE] Oh, correct.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] And then the calendar year maximum for the inpatient, um, well, actually the benefits are the same for both. So it's a max of $8500 per calendar year.
[AGENT][NEUTRAL] You um
[CUSTOMER][NEUTRAL] Is that split between the two, or it could be a total of 17,000 paid?
[AGENT][NEUTRAL] Right, a total of 17. It's 8500 for both inpatient and outpatient per year.
[CUSTOMER][NEUTRAL] OK, OK, and they both would and maternity is covered.
[AGENT][NEUTRAL] So
[AGENT][NEUTRAL] So it's not like um a major insurance where it's per service, it's facility, so the secondary pays for the co-pay, deductible and co-insurance.
[CUSTOMER][NEUTRAL] Right.
[CUSTOMER][NEUTRAL] Got you OK and has she used any of these benefits for this year so far?
[AGENT][NEUTRAL] Let me check for you. Hold on one second.
[AGENT][NEUTRAL] Hold on one moment.
[CUSTOMER][POSITIVE] Take your time.
[AGENT][NEGATIVE] Because too far.
[AGENT][POSITIVE] I'm glad I caught this. Hold on one second. So the, let me see if these benefits are different. Hold on.
[CUSTOMER][POSITIVE] No problem, take your time.
[AGENT][NEUTRAL] And then was outpatient.
[AGENT][NEUTRAL] OK, so
[AGENT][NEUTRAL] The dollar amount I said is different. Um, I typed a 6 instead of a $249 246. So I the correct um calendar year max is $7900 for both, it's still each, um, inpatient and outpatient, and then, um.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] Yeah, it's still not broken down into like ma.
[CUSTOMER][NEGATIVE] Gotcha.
[AGENT][NEUTRAL] The services that
[CUSTOMER][NEUTRAL] But it would be ineligible expense if it's inpatient or outpatient it's just broken down by place of service more than yeah.
[AGENT][POSITIVE] Place of service, correct. Mhm.
[CUSTOMER][NEUTRAL] And has she used anything?
[AGENT][NEUTRAL] No, she hasn't used anything for this year.
[CUSTOMER][NEUTRAL] Of either.
[CUSTOMER][NEUTRAL] Not new, no news perfect and is there any policy limitations or it's just good for the calendar year as far as you guys are concerned?
[AGENT][NEUTRAL] Mm.
[AGENT][NEUTRAL] I'm good for the calendar year as long as primary applies will apply. If they don't, we can't, um, but that's the only.
[CUSTOMER][NEUTRAL] Got
[CUSTOMER][NEUTRAL] All right, [PII], can I get a call reference number?
[AGENT][NEUTRAL] Sure, so there's no call reference number, but you can use my name in today's date. Um, the first initial to my last name is [PII].
[CUSTOMER][POSITIVE] Perfect thank you so much for your help you have a great day.
[AGENT][POSITIVE] You're very welcome and thanks for calling APL. I hope you have a great day as well, [PII]. Bye-bye.
[CUSTOMER][POSITIVE] Take care bye bye.