AccountId: 011433970860
ContactId: 68ec348c-fe7f-493d-b791-bb3e5121cfad
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 363420 ms
Total Talk Time (AGENT): 134409 ms
Total Talk Time (CUSTOMER): 175466 ms
Interruptions: 1
Overall Sentiment: AGENT=1.6, CUSTOMER=0.2
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/01/13/68ec348c-fe7f-493d-b791-bb3e5121cfad_20250113T19:28_UTC.wav
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[AGENT][NEUTRAL] Thank you for calling APL. This is [PII]. How can I help you?
[CUSTOMER][NEUTRAL] Yeah
[CUSTOMER][NEUTRAL] Hey, [PII], my name is [PII] and I'm calling from Doctor [PII]'s office. Um, got a patient. We need to verify that, um, you all have us as a participating provider for you all.
[AGENT][POSITIVE] OK. Happy to take a look, [PII]. Do you have the patient's policy number?
[CUSTOMER][NEUTRAL] I do. It is 02566204.
[AGENT][NEUTRAL] All right, thank you, [PII]. Let me pull this up here.
[CUSTOMER][NEUTRAL] OK, all right.
[AGENT][NEUTRAL] All right. And let's see if I could get the patient's name and date of birth?
[CUSTOMER][NEUTRAL] Name is [PII]
[CUSTOMER][NEUTRAL] Is it [PII]
[AGENT][NEUTRAL] Uh-huh.
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] All right, thank you so much. So patient plan is active. The effective date if you need that is [PII]. Um, this is a limited benefit medical plan, so a hospital indemnity. There's no specific network required for use. It just pays a certain amount depending upon what they're being seen for.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK, so it's not, because they say this is not a major medical plan. So is, is it a medical plan where he can go to a primary care physician?
[AGENT][POSITIVE] Correct.
[AGENT][NEUTRAL] Yeah, so.
[CUSTOMER][NEUTRAL] Or is it just for hospital?
[AGENT][NEUTRAL] No, they can go. Let's see what the office visit is here.
[CUSTOMER][NEUTRAL] OK
[CUSTOMER][NEUTRAL] You
[CUSTOMER][POSITIVE] Thank
[CUSTOMER][NEUTRAL] Did you talk to [PII] this morning about her insurance and she's gonna call you back.
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] She
[AGENT][NEUTRAL] So like they can go and see a physician, so for like an office visit to see a physician, it's gonna pay a benefit amount of $75 per visit and they're allowed, it looks 6 office visits in a calendar year.
[CUSTOMER][NEUTRAL] I
[CUSTOMER][NEUTRAL] Or
[CUSTOMER][NEUTRAL] 6 office.
[CUSTOMER][NEUTRAL] This is.
[CUSTOMER][NEUTRAL] In a year. OK, so you're saying it only pays like 75%, so pretty much they'll be responsible for the rest.
[AGENT][NEUTRAL] Right, that's all the benefit plan is gonna pay towards their visit, correct.
[CUSTOMER][NEUTRAL] Hey
[CUSTOMER][NEUTRAL] So like when we file I just had to pass this on to the bill so when we file like the um claim and everything.
[CUSTOMER][NEUTRAL] Uh, you know, like, like Blue Cross or whatever, they have their deductibles and whatnot, but this one, it only pays $75. So if he come in here and have a physical for $660.
[AGENT][NEUTRAL] Mhm, mhm.
[AGENT][NEUTRAL] Mhm.
[AGENT][NEUTRAL] Yes, ma'am.
[AGENT][NEUTRAL] Yes, ma'am.
[CUSTOMER][NEUTRAL] All they're gonna pay is 75.
[AGENT][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] Wow, and that includes lab work and anything like if you have to have blood work?
[AGENT][NEUTRAL] Let me see if there's anything.
[CUSTOMER][NEUTRAL] He'll pretty much be responsible for that too.
[AGENT][NEUTRAL] Let me see if there's anything.
[CUSTOMER][NEUTRAL] OK, I'll let her know and if she doesn't need to call you, she won't be if this is what she needed, OK.
[AGENT][NEUTRAL] Different for labs sometimes the plan, you know, will pay. Let's see.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][POSITIVE] OK fine, thank you so much.
[AGENT][NEUTRAL] So like the plan has like a health screening benefit which would consider like a physical. So like, you know, a physical looks like it pays 150.
[AGENT][NEUTRAL] Um,
[CUSTOMER][NEUTRAL] OK, hold on, let me write physical because I think that's where he's trying to get a new patient physical.
[CUSTOMER][NEUTRAL] Physical 150.
[AGENT][NEUTRAL] Let me see.
[AGENT][NEUTRAL] OK, so.
[AGENT][POSITIVE] It has a diagnostic benefit on it. It looks like $100.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] And that's it. Patient has come out of pocket with the rest.
[AGENT][NEUTRAL] Yeah, I don't see a lot of this other stuff is like physical therapy, you know, it would be more, it's more specific.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] But a physical, like if we were to go.
[CUSTOMER][NEUTRAL] With our insurance.
[CUSTOMER][NEGATIVE] They would, you know, file it to the insurance and what's left over, that's what would be responsible, but once they pay this 150, then they're still gonna have to come out of pocket.
[AGENT][NEUTRAL] Yes, ma'am. Uh-huh.
[CUSTOMER][NEUTRAL] If the fee is 650, OK, I just wanna make sure.
[AGENT][NEUTRAL] Yeah.
[AGENT][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] Oh.
[AGENT][NEUTRAL] Yeah, I mean we don't know if they have any other coverage. You would have to check with them if they had any other like additional coverage. I don't know.
[CUSTOMER][NEUTRAL] So the
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] But that's all it's gonna cover is 150.
[CUSTOMER][NEUTRAL] So do, so that means you all don't have like participating providers they can go anywhere they want to go.
[AGENT][POSITIVE] Correct.
[AGENT][POSITIVE] Correct. Uh-huh.
[CUSTOMER][POSITIVE] OK, I do appreciate your time.
[AGENT][POSITIVE] Yeah, not a problem. Anything else I can check on for you?
[CUSTOMER][NEUTRAL] Um, that'll be it.
[AGENT][POSITIVE] Alright, thanks for calling APL have a good day.
[CUSTOMER][NEUTRAL] You too bye bye.
[AGENT][NEUTRAL] Bye bye