AccountId: 011433970860
ContactId: 6dd0fddc-f595-4005-bb0d-25e686c47b13
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 323410 ms
Total Talk Time (AGENT): 110552 ms
Total Talk Time (CUSTOMER): 145614 ms
Interruptions: 0
Overall Sentiment: AGENT=1.5, CUSTOMER=0.2
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/01/14/6dd0fddc-f595-4005-bb0d-25e686c47b13_20250114T18:52_UTC.wav
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[AGENT][NEUTRAL] Thank you for calling American Public Life. This is [PII]. How may I help you?
[CUSTOMER][NEUTRAL] Hi, good morning, [PII]. My name is [PII] and I'm calling with Heart of the Rockies, and I am calling um to verify.
[CUSTOMER][NEUTRAL] Information eligibility on a patient.
[AGENT][NEUTRAL] I can verify eligibility, [PII]. May I have a policy number?
[CUSTOMER][NEUTRAL] Yes, so that is, let me get back to the card.
[CUSTOMER][NEUTRAL] Policy number is 02447401.
[AGENT][POSITIVE] Thank you. And may I have a good callback number for you?
[CUSTOMER][NEUTRAL] Yes, ma'am. It's [PII].
[AGENT][NEUTRAL] Thank you, may I have the patient's name and date of birth?
[CUSTOMER][NEUTRAL] Yes, on the card it's [PII]
[AGENT][NEUTRAL] And date of birth.
[CUSTOMER][NEUTRAL] Date of birth is [PII].
[AGENT][POSITIVE] Thank you for verifying that information. This plan is effective [PII] and it is active.
[CUSTOMER][NEUTRAL] OK, um let me see.
[CUSTOMER][NEUTRAL] Let me see if there's any other information. Is there anything else I need to know about like deductible, um,
[CUSTOMER][NEUTRAL] Is it vary from clinic to hospital?
[AGENT][NEUTRAL] Where would the place of service be?
[CUSTOMER][NEUTRAL] Um, so it does look like
[CUSTOMER][NEUTRAL] Saida, Heart of the Rockies.
[CUSTOMER][NEUTRAL] And um
[CUSTOMER][NEUTRAL] Both clinic and hospital.
[AGENT][NEUTRAL] So please be advised that verification of coverage does not guarantee the payment of a claim. So any outpatient per calendar year, this plan allows 1500. If there is treatment in the clinic, it falls under the same benefit. It does not have office visit benefits.
[CUSTOMER][NEUTRAL] OK
[CUSTOMER][NEUTRAL] OK, so no office visit benefits.
[CUSTOMER][NEUTRAL] And for hospital side, it, the 1500 is that deductible?
[AGENT][NEUTRAL] It will pick up the copays, the co-insurance, and our deductible. This plan follows the primary, it's their secondary policy.
[CUSTOMER][NEUTRAL] OK, I'm just trying to take notes of all this. So no office visit benefits, so it does not cover anything for clinic side at all.
[AGENT][NEUTRAL] Office treatment. Any treatment received in the office, whether it be the injections, labs in the office, anything like that as a treatment, just not the actual office visit itself.
[CUSTOMER][NEUTRAL] OK, any treatment in office is not covered. And then patient.
[AGENT][NEUTRAL] It's covered.
[CUSTOMER][NEUTRAL] Treatments are covered.
[AGENT][POSITIVE] Correct.
[CUSTOMER][NEUTRAL] OK, I'm confused. I'm so sorry, [PII]. So when, OK, when you said no office visit benefits, what does that mean?
[AGENT][NEUTRAL] No, you're fine.
[AGENT][NEUTRAL] The office visit itself.
[AGENT][NEUTRAL] The actual office visit.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] So the office visit is not covered, but treatments are.
[AGENT][POSITIVE] Correct.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] And then for anything hospital side, patient has a $1500 deductible that has to be met prior to coverage.
[AGENT][NEUTRAL] No, ma'am, this plan will pick up the co-pays, the co-insurance, and our deductible up to 1500.
[AGENT][NEUTRAL] For any outpatient services.
[CUSTOMER][NEUTRAL] OK, so any co-pays, co-insurance and deductible that the primary insurance will not cover, um, this APL will cover up to $1500 and then after that it's patients responsibility.
[AGENT][POSITIVE] Yes, ma'am, that is correct.
[CUSTOMER][NEUTRAL] OK, [PII], do you happen to have an employee number or a reference number to this call?
[AGENT][NEUTRAL] The reference number will be my name, which is [PII] Last [PII] [PII] along with today's date. [PII], is there anything else I can assist you with?
[CUSTOMER][NEUTRAL] Um, let me just go back and read this note and make sure that I have everything in here.
[CUSTOMER][NEUTRAL] You did say the effective date was [PII] and it is still currently active.
[AGENT][POSITIVE] That is correct.
[CUSTOMER][NEUTRAL] OK. All right, that's what I needed and the reference number is [PII] W01142025.
[AGENT][NEUTRAL] Yes, ma'am.
[CUSTOMER][POSITIVE] OK. Thank you so much, [PII]. Have a good day.
[AGENT][POSITIVE] [PII], you're so welcome and thank you for calling American Public Life. Have a great day. Bye-bye.
[CUSTOMER][NEUTRAL] You too. Bye bye.