AccountId: 011433970860
ContactId: 68f30e24-fcbd-4e0b-b10e-c8f54e4575ff
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 327980 ms
Total Talk Time (AGENT): 101507 ms
Total Talk Time (CUSTOMER): 117406 ms
Interruptions: 0
Overall Sentiment: AGENT=0.6, CUSTOMER=0.6
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/02/14/68f30e24-fcbd-4e0b-b10e-c8f54e4575ff_20250214T19:39_UTC.wav
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[AGENT][NEUTRAL] Calling APL, my name is [PII]. How may I assist you today?
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Hi [PII]. I'm not sure if I'm calling the right department, but um I was calling from provider's office to verify patients eligibility status and benefit coverage and copays.
[AGENT][POSITIVE] I'd be happy to assist with eligibility and benefits. May I have your first name please?
[CUSTOMER][POSITIVE] Perfect
[CUSTOMER][NEUTRAL] [PII] initial is [PII].
[AGENT][POSITIVE] And can, if I can get a good callback number for you?
[CUSTOMER][NEUTRAL] Sure it is [PII], no extension.
[AGENT][NEUTRAL] And what is the policy number?
[CUSTOMER][NEUTRAL] That's
[CUSTOMER][NEUTRAL] Um, [PII].
[AGENT][NEUTRAL] Patient's name and date of birth?
[CUSTOMER][NEUTRAL] For [PII].
[AGENT][NEUTRAL] Date of birth?
[CUSTOMER][NEUTRAL] Oh sorry, um, [PII].
[AGENT][NEUTRAL] Thank you for that information. Please be advised the verification of coverage is not a guarantee of payment. I do show the policy is currently active, effective date is [PII]. And are you calling for inpatient or outpatient benefits?
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Um, outpatient, oh, do you see any termination date for the policy?
[CUSTOMER][NEUTRAL] No.
[AGENT][NEUTRAL] No, I'm showing the policy is still active.
[CUSTOMER][POSITIVE] Alright perfect.
[AGENT][NEUTRAL] And where will treatment take place?
[CUSTOMER][NEUTRAL] In the office?
[AGENT][NEUTRAL] OK, I do show patient does have benefits for treatment in an office. Patient has 5 visits per calendar year with a benefit amount of $75 per visit.
[CUSTOMER][NEUTRAL] 75 copay.
[CUSTOMER][NEUTRAL] Um, does that count or is that the same with the diagnostic X-ray done in the office? $75 as well?
[AGENT][POSITIVE] That's correct.
[CUSTOMER][NEUTRAL] Oh, OK, interesting. I don't call, um, how about for your routine physical wellness preventive.
[AGENT][NEUTRAL] Um, preventative, uh, the wellness preventative is $250 per calendar year.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Oh, it is not covered?
[AGENT][NEGATIVE] I don't understand.
[AGENT][NEUTRAL] You said her wellness?
[CUSTOMER][NEUTRAL] Yes, the routine physical?
[AGENT][NEUTRAL] That would be considered under the wellness and she has a $250 per calendar year.
[CUSTOMER][NEUTRAL] Oh, OK.
[CUSTOMER][NEGATIVE] And no copay correct.
[AGENT][NEUTRAL] No, it's just the benefit amount that we'll pay anything over that benefit amount that we pay would be her responsibility.
[CUSTOMER][NEUTRAL] OK, got you.
[CUSTOMER][NEUTRAL] No, I call on $250.
[CUSTOMER][NEUTRAL] Benefit amount let me take note of that here.
[CUSTOMER][NEUTRAL] Right, um, does she have any, um, referral, I mean, is a referral required for this patient?
[AGENT][NEUTRAL] No.
[CUSTOMER][NEUTRAL] No re required.
[CUSTOMER][NEUTRAL] Does she have any maternity benefits and birth control in general?
[AGENT][NEUTRAL] Uh, birth control is not covered.
[CUSTOMER][NEUTRAL] OK
[CUSTOMER][NEUTRAL] No BC.
[CUSTOMER][NEUTRAL] 5 per year.
[AGENT][NEUTRAL] Was there anything else I can assist with today?
[CUSTOMER][NEUTRAL] Oh, the maternity benefit?
[AGENT][NEUTRAL] Oh, I'm sorry. um, so maternity is just based on her up to her coverage maximum.
[CUSTOMER][NEUTRAL] What
[AGENT][NEUTRAL] So, it will be the 5 office visits.
[AGENT][NEUTRAL] It would be the
[AGENT][NEUTRAL] For the inpatient.
[AGENT][NEUTRAL] Um,
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] For hospital benefit, it would be um
[AGENT][NEUTRAL] $500 for admission and $50 per day of confinement.
[AGENT][NEUTRAL] But we're not a major medical policy, so.
[CUSTOMER][NEUTRAL] OK, I see, alright, um, how about, um, a, uh, the delivery in the office setting, is that covered?
[AGENT][NEUTRAL] Up to her office visit maximums.
[CUSTOMER][NEUTRAL] Out to her office, OK, maternity.
[CUSTOMER][POSITIVE] Alrighty, OK, I got everything that I need. Thank you so much for your help and assistance. May I have this, um, reference number of this call. Thank you.
[AGENT][NEUTRAL] Reference is just my name [PII] last initial [PII], and the date and time of the call.
[CUSTOMER][NEUTRAL] Alright, [PII].
[CUSTOMER][POSITIVE] Alright, thank you so much [PII] have a good one bye for now.
[AGENT][POSITIVE] Thank you for calling APO have a good day.
[CUSTOMER][POSITIVE] You too too.