AccountId: 011433970860
ContactId: 7360ffe9-1ffa-4254-8ec2-3fa17bf15851
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 619580 ms
Total Talk Time (AGENT): 199038 ms
Total Talk Time (CUSTOMER): 269508 ms
Interruptions: 2
Overall Sentiment: AGENT=0.9, CUSTOMER=0
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/04/04/7360ffe9-1ffa-4254-8ec2-3fa17bf15851_20250404T14:44_UTC.wav
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[AGENT][POSITIVE] Thank you for calling American Public Life. This is [PII]. How can I help you?
[CUSTOMER][NEUTRAL] Hey, my name is [PII]. Lastly surname is [PII].
[AGENT][NEUTRAL] Could I get a callback number please?
[CUSTOMER][NEUTRAL] Yeah, the callback number is [PII]. It's a direct line.
[AGENT][NEUTRAL] OK. Can I get the policy number you're calling on?
[CUSTOMER][NEUTRAL] Oh
[CUSTOMER][NEUTRAL] OK
[CUSTOMER][NEUTRAL] Yeah, yeah. Uh, D as in Delta, 4370.
[AGENT][NEUTRAL] OK, that's not one of our policy numbers.
[AGENT][NEUTRAL] Do you have a social for the patient?
[CUSTOMER][NEUTRAL] So do you know the right department?
[CUSTOMER][NEUTRAL] Sorry?
[AGENT][NEUTRAL] Do you have a social for the patient?
[CUSTOMER][NEUTRAL] I can check that one, just a second.
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Oh
[CUSTOMER][NEUTRAL] Uh, yeah, I have. So the Social Security number I have here is [PII].
[CUSTOMER][NEUTRAL] [PII], sorry, sorry for that. [PII].
[AGENT][NEUTRAL] The patient's name?
[CUSTOMER][NEUTRAL] I
[CUSTOMER][NEUTRAL] Uh, [PII], and the date of birth is [PII].
[AGENT][POSITIVE] OK. Thank you so much for verifying the policy. Are you calling for claim status or benefits?
[CUSTOMER][NEUTRAL] Al
[CUSTOMER][NEUTRAL] I, uh, actually, I need a PCP office visit benefit and uh I have a CCPD code.
[AGENT][NEUTRAL] OK, I don't need the code.
[AGENT][NEUTRAL] OK, please be advised verifying that. Please, I'm sorry.
[CUSTOMER][NEUTRAL] OK. So, if you don't need the code,
[CUSTOMER][NEUTRAL] Uh, sorry for disturbing you. Uh, if you don't need the code, so I can provide you only the description, so it's fine.
[AGENT][NEUTRAL] OK, yes, it is the office visit. You're calling for office visit benefits.
[CUSTOMER][NEUTRAL] OK. OK.
[AGENT][NEUTRAL] OK, please be advised verifying benefits does not guarantee payment. This policy has been effective since [PII]. It is still active.
[CUSTOMER][NEUTRAL] Yeah, office visit.
[CUSTOMER][NEUTRAL] And
[CUSTOMER][NEUTRAL] Yes
[AGENT][NEUTRAL] For a physician visit, the policy pays $75 a visit.
[AGENT][NEUTRAL] The patient has 3 visits a year.
[CUSTOMER][NEUTRAL] OK, just so I can write down here $75 visit, right?
[AGENT][NEUTRAL] Mm, let me make sure of this. Hold one moment please.
[CUSTOMER][NEGATIVE] You are on hold.
[AGENT][NEUTRAL] Uh yes, it is.
[AGENT][NEUTRAL] Yeah, 75 and 5, is it 5?
[AGENT][NEUTRAL] Mm, OK.
[AGENT][NEUTRAL] OK, thank you so much for holding. I apologize for the wait. This policy will pay $75 for the visit. The patient has 5 visits a year to use. Uh, at this time, I show all are available for [PII].
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK, so you said that $75 per visit, uh, right?
[CUSTOMER][NEUTRAL] Hello?
[AGENT][NEUTRAL] Yes. Did you have a question?
[CUSTOMER][NEUTRAL] Yeah, 75. Yeah, I have the question. $75 per visit, 5 visits is uh uh 5 visits total, and uh how many visitors left now?
[AGENT][NEUTRAL] All are available for 2025.
[CUSTOMER][NEUTRAL] Uh.
[CUSTOMER][NEUTRAL] OK. Thank you for that. And I have a description for the 50 codes. Please check that that this code is covered or not. It's fine.
[AGENT][NEUTRAL] I cannot guarantee payment for a physician visit. A physician sick visit, the policy pays $75 a visit.
[CUSTOMER][NEUTRAL] So, can I provide you this?
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEGATIVE] I cannot guarantee payment.
[CUSTOMER][NEUTRAL] OK, I got it. So, can I provide you the date?
[CUSTOMER][NEUTRAL] But now, can I provide the descriptions of the CD? It's fine. You said it's cannot get the payment. I got it.
[AGENT][NEUTRAL] Sure.
[CUSTOMER][NEUTRAL] But please check that, that, like, uh, OK, thank you. The 1st 4 code description is a preventive care.
[CUSTOMER][NEUTRAL] Immunization, preventative care, immunization, or and the, it's a routine. And the last two is a diagnostic testing, non-routine. It's a medical. And please also check in.
[AGENT][NEUTRAL] OK, so these are not physicians take visits. These are routine visits.
[AGENT][NEUTRAL] These are not sick visits, correct? OK. Hold one moment.
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEGATIVE] No, no, no. You are on hold.
[AGENT][NEGATIVE] This idiot.
[AGENT][POSITIVE] Oh my gosh.
[AGENT][NEUTRAL] OK. Thank you for holding. For the physician, for a routine, it does pay the $75 for the visit, for any diagnostic. Oh my God. It is the same, yes.
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] OK, it's also the same.
[CUSTOMER][NEUTRAL] And the diagnostic?
[CUSTOMER][NEUTRAL] I
[AGENT][NEUTRAL] Pays up to $250 per year.
[CUSTOMER][NEUTRAL] Per year.
[CUSTOMER][NEUTRAL] OK. OK. Uh
[CUSTOMER][NEUTRAL] OK. So you said for the routine is $75 copay.
[AGENT][NEUTRAL] It's not a co-pay. The policy pays $75.
[CUSTOMER][NEUTRAL] finish
[CUSTOMER][NEUTRAL] Oh.
[CUSTOMER][NEUTRAL] OK, sorry for that. $75. And for the non-routine, the diagnostic testing is a non-routine. So so you said it's a $250 per year.
[AGENT][NEUTRAL] Did you say it's non-routine or is it for routine?
[CUSTOMER][NEUTRAL] Uh, sorry, but the diagnostic testing is a non-routine and the preventative care immunization is a routine.
[AGENT][NEUTRAL] OK, so for the preventative, it's $75.
[CUSTOMER][NEUTRAL] And
[CUSTOMER][NEUTRAL] I
[AGENT][NEUTRAL] For the non-routine?
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] And
[AGENT][NEUTRAL] It's gonna be the, the maximum of $75 for the visit.
[CUSTOMER][NEUTRAL] So the non-routine also same and the routine also same.
[AGENT][POSITIVE] Correct.
[CUSTOMER][NEUTRAL] OK, it's $75 per visit, right?
[AGENT][POSITIVE] Correct.
[AGENT][POSITIVE] Correct.
[CUSTOMER][NEUTRAL] OK, both are the same.
[CUSTOMER][NEUTRAL] I got it, just a second. And the lab was the same, ma'am?
[AGENT][NEUTRAL] It is.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] And is it a limited plan?
[AGENT][NEUTRAL] It is.
[CUSTOMER][NEUTRAL] OK, Limited plan. OK. And can you confirm me the ID number you said uh the D as in Delta, that ID number is correct?
[AGENT][NEUTRAL] Uh, let me provide you with the correct policy number. The correct policy number is
[CUSTOMER][NEUTRAL] Yeah.
[AGENT][NEUTRAL] 1756793.
[CUSTOMER][NEUTRAL] 1756793.
[AGENT][NEUTRAL] Yes.
[CUSTOMER][NEUTRAL] 756-793. OK.
[CUSTOMER][NEUTRAL] Just a second.
[CUSTOMER][NEUTRAL] Uh, is it a 90-degree benefit multi-plan, employer group plan?
[AGENT][NEUTRAL] I'm sorry?
[CUSTOMER][NEUTRAL] The insurance name is a 90-degree benefits Multiplan.
[AGENT][NEUTRAL] The policy name is American Public Life.
[CUSTOMER][NEUTRAL] Yeah
[CUSTOMER][NEUTRAL] American Public line. OK. I can write down here because my systems will be different and you said it's different. That's why. American?
[AGENT][NEUTRAL] Public life.
[CUSTOMER][NEUTRAL] Public line.
[CUSTOMER][NEUTRAL] I got it. Public life.
[AGENT][POSITIVE] Correct.
[CUSTOMER][NEUTRAL] Public life you said. OK.
[CUSTOMER][NEUTRAL] LIFE Life, OK.
[CUSTOMER][NEUTRAL] Oh
[CUSTOMER][NEUTRAL] Give me a moment.
[CUSTOMER][NEUTRAL] And is there a limit and any of this code you see that we have pre-authorization is required?
[AGENT][NEUTRAL] Pre-authorization is not required for the policy.
[CUSTOMER][NEUTRAL] OK. Any exclusion?
[AGENT][NEUTRAL] No exclusions.
[CUSTOMER][NEUTRAL] You
[CUSTOMER][NEUTRAL] OK. And is, is it a PPO plan?
[AGENT][NEUTRAL] Is it a, it's a limited medical plan. This policy does not have a contract.
[CUSTOMER][NEUTRAL] OK. And it's a calendar the plan here.
[AGENT][NEUTRAL] Yes.
[AGENT][NEUTRAL] Calendar year.
[CUSTOMER][NEUTRAL] Calendar year.
[CUSTOMER][NEUTRAL] And the patient name can confirm it [PII], this patient name.
[AGENT][NEUTRAL] Can I confirm his name?
[CUSTOMER][NEUTRAL] Yeah
[CUSTOMER][NEUTRAL] Yeah, yeah, because I have 2 patients, so which patient I'm giving to you, I don't know. That's uh, sorry for that. So it's a direct.
[AGENT][NEUTRAL] You ask for [PII].
[CUSTOMER][NEUTRAL] OK, [PII].
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] So
[CUSTOMER][POSITIVE] Thank you for that, ma'am. Uh spell your name.
[AGENT][NEUTRAL] [PII]
[CUSTOMER][NEUTRAL] [PII] And the reference number, last name.
[AGENT][NEUTRAL] My name, my name, and today's date.
[CUSTOMER][NEUTRAL] [PII]
[CUSTOMER][NEUTRAL] A
[CUSTOMER][POSITIVE] And today's date. Thank you for that. Thank you. Have a nice day.
[AGENT][POSITIVE] Correct.
[AGENT][POSITIVE] You have a wonderful weekend. Thank you for calling APL Sam. Bye-bye.