AccountId: 011433970860
ContactId: 62b1dc52-5b9f-496b-a3ce-f1c83d55652c
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 261899 ms
Total Talk Time (AGENT): 81345 ms
Total Talk Time (CUSTOMER): 88846 ms
Interruptions: 0
Overall Sentiment: AGENT=0.6, CUSTOMER=0.3
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/03/25/62b1dc52-5b9f-496b-a3ce-f1c83d55652c_20250325T14:51_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 morning. This is [PII]. I'm calling from Doctor Mea's office trying to get benefits, uh, for a member, please.
[AGENT][NEUTRAL] Hi, good morning, this is [PII].
[AGENT][POSITIVE] OK, [PII], I can help you with benefits. Do you have a good callback number?
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] And you have the policy number?
[CUSTOMER][NEUTRAL] The policy number 02099835M as in Mary L as in Larry 8.
[AGENT][NEUTRAL] OK, thank you. And you have the patient name and date of birth?
[CUSTOMER][NEUTRAL] [PII], [PII].
[AGENT][POSITIVE] OK, thank you.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] And you just needed eligibility?
[CUSTOMER][NEUTRAL] Yeah, actually for uh surgical procedure, um, done in office and also for a minor diagnostic like ultrasounds being done at the office specialist.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] This is not a guarantee of payments basic outline of the policy. Let me get pull up her policy.
[AGENT][NEUTRAL] She's effective [PII] and active.
[AGENT][NEUTRAL] And let's see.
[AGENT][NEUTRAL] So for her outpatient benefit, she has a $500 per covered person per calendar day benefit.
[CUSTOMER][NEUTRAL] OK, and how much is um her maximum coverage?
[AGENT][NEUTRAL] Uh, it's 500 per day.
[CUSTOMER][NEUTRAL] For how many days?
[AGENT][NEUTRAL] Uh, there's not a limit on the days.
[CUSTOMER][NEUTRAL] Oh, OK, so, OK, there's no limit then it's uh $500 per day unlimited.
[AGENT][NEUTRAL] Yes, correct. And then so that's gonna.
[CUSTOMER][NEUTRAL] She doesn't have like a maximum coverage?
[AGENT][NEUTRAL] Yeah, that's just the, it's just 500 per day. Yeah.
[CUSTOMER][NEUTRAL] OK, and there's no deductible to meet prior to um receiving coverage?
[AGENT][NEUTRAL] No, there's not. Um, we do process a secondary though, so we will need that primary explanation of benefits in order to consider the claim.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] All right. And do you cover all types of services or just surgical?
[AGENT][NEUTRAL] Um, so it's gonna be.
[AGENT][NEUTRAL] Let's see
[AGENT][NEUTRAL] Let me make sure there is.
[AGENT][NEUTRAL] And you are, you are an office correct? not a hospital or free standing?
[CUSTOMER][NEUTRAL] Yeah, a specialist, right, not a hospital or or a facility, no, it's just an office specialist office.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] And I'm looking to see if, make sure that that's covered.
[AGENT][NEUTRAL] Uh, OK, so for the actual office visit itself that is not a covered benefit.
[AGENT][NEUTRAL] But any treatment or procedure in the doctor's office is covered under that $500 per day benefit.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK, perfect. Alright, and let me just confirm mailing address for claims the [PII].
[AGENT][POSITIVE] That is correct.
[CUSTOMER][POSITIVE] OK thank you very much for your help you have a good day bye bye.