AccountId: 011433970860
ContactId: 6852e30d-8adf-40a4-bf62-9bdb29db8aed
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 362799 ms
Total Talk Time (AGENT): 136636 ms
Total Talk Time (CUSTOMER): 134802 ms
Interruptions: 1
Overall Sentiment: AGENT=0.7, CUSTOMER=0.4
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/04/17/6852e30d-8adf-40a4-bf62-9bdb29db8aed_20250417T15:20_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] calling from Doctor [PII]'s office. I need to check uh benefits on a patient, please.
[AGENT][NEUTRAL] I'm sure [PII], I can assist you with benefits. Um, first, could I get a good callback number just in case we're disconnected?
[CUSTOMER][NEUTRAL] Something certificate.
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] Thank you. Now I need the policy number, please.
[CUSTOMER][NEUTRAL] Policy number is 0186.
[CUSTOMER][NEUTRAL] 886 8.
[AGENT][NEUTRAL] And please verify the patient's name and date of birth.
[CUSTOMER][NEGATIVE] We don't even give you
[CUSTOMER][NEUTRAL] It's [PII] [PII].
[AGENT][NEUTRAL] Thank you and just let me advise you the verification of coverage does not guarantee payment of claims. Um, I'm showing the effective date on this policy was [PII]. The policy is still active.
[CUSTOMER][POSITIVE] But anyway, ready.
[CUSTOMER][NEUTRAL] Is what?
[CUSTOMER][NEUTRAL] What is it, ma'am?
[AGENT][NEUTRAL] [PII].
[CUSTOMER][NEUTRAL] Uh, any anything and go to that part.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] And the policy is still active?
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] And is this for inpatient or outpatient benefits or an office visit?
[CUSTOMER][NEUTRAL] It's an office is it, ma'am.
[AGENT][NEUTRAL] OK, for services provided that.
[CUSTOMER][NEUTRAL] A specialist.
[AGENT][NEUTRAL] OK. Including specialist office visits, um, for services provided in office. We cover up to 2550 per calendar year and that's for the co-insurance and the deductible after the primary insurance processes the claim, but the co-pay for the office visit is not covered.
[CUSTOMER][NEUTRAL] Yes.
[CUSTOMER][POSITIVE] Yeah, no problem.
[CUSTOMER][NEUTRAL] OK, so this is the secondary to primary insurance.
[AGENT][NEUTRAL] Yes, it is.
[CUSTOMER][NEUTRAL] OK, and you can cover up to 2500?
[AGENT][NEUTRAL] 2550 per calendar year.
[CUSTOMER][NEUTRAL] Has he met any?
[AGENT][NEUTRAL] No, he hasn't met any yet.
[CUSTOMER][NEUTRAL] So
[CUSTOMER][NEUTRAL] OK, you don't cover the co-pay, right?
[AGENT][NEUTRAL] Right, not for office visits, no, ma'am.
[CUSTOMER][NEUTRAL] The
[CUSTOMER][NEUTRAL] OK, is Doctor, uh, see by network with you guys contracted?
[AGENT][NEUTRAL] Um, there is no network. We work with our providers, but if the primary insurance carrier does not cover charge, we don't cover it either.
[CUSTOMER][NEUTRAL] Mhm
[CUSTOMER][NEUTRAL] OK
[CUSTOMER][NEUTRAL] OK. OK. Um.
[CUSTOMER][NEUTRAL] Mm, and the billing address, is it the [PII]?
[AGENT][NEUTRAL] Um, no, that's the old one. The new billing address is.
[CUSTOMER][NEUTRAL] Mhm
[AGENT][NEUTRAL] [PII].
[CUSTOMER][NEUTRAL] [PII]
[AGENT][NEUTRAL] Yes, ma'am.
[CUSTOMER][NEUTRAL] Only 18?
[AGENT][NEUTRAL] And that's
[AGENT][NEUTRAL] Yeah, only 18.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] And that's in [PII], [PII].
[AGENT][NEUTRAL] And the zip code is [PII].
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK, hold on one second.
[AGENT][NEUTRAL] And you could repeat it back to me if you like.
[CUSTOMER][NEUTRAL] Mhm let me just look and it's under.
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] [PII].
[CUSTOMER][NEUTRAL] OK, it's um [PII] [PII], [PII].
[AGENT][POSITIVE] Oh, no, it's, I'm sorry.
[AGENT][NEUTRAL] No, it's [PII].
[CUSTOMER][NEUTRAL] [PII].
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] Right.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] [PII]
[CUSTOMER][NEUTRAL] [PII].
[CUSTOMER][NEUTRAL] City.
[CUSTOMER][NEUTRAL] [PII].
[CUSTOMER][NEUTRAL] 24.
[CUSTOMER][NEUTRAL] [PII]
[AGENT][NEUTRAL] Um,
[AGENT][NEUTRAL] Yeah, [PII].
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Uh, what's OK, it's paper.
[AGENT][NEUTRAL] Paper, yeah, if you file the claim through mail. Yes, ma'am.
[CUSTOMER][NEUTRAL] OK, with the primary you'll be.
[AGENT][POSITIVE] That's correct.
[CUSTOMER][POSITIVE] Sure, OK, thank you so much. Can I have a reference number here?
[AGENT][NEUTRAL] I
[AGENT][NEUTRAL] Yes, for the reference number, you can use my name and today's date. Um my name is spelled [PII] Last initial is [PII] and today's date. Is there anything else I can assist you with?
[CUSTOMER][POSITIVE] No, that's it. Thank you so much for your help.
[AGENT][POSITIVE] OK, I thank you for calling APA Blanca. Have a great rest of your day. Mm bye.
[CUSTOMER][NEUTRAL] You too bye bye.
[AGENT][POSITIVE] Thank you.