AccountId: 011433970860
ContactId: 73cee1fb-b8ff-47ff-b4d4-2e7a0600c0af
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 542219 ms
Total Talk Time (AGENT): 213903 ms
Total Talk Time (CUSTOMER): 202721 ms
Interruptions: 1
Overall Sentiment: AGENT=0.6, CUSTOMER=0.4
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/02/19/73cee1fb-b8ff-47ff-b4d4-2e7a0600c0af_20250219T14:55_UTC.wav
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[AGENT][POSITIVE] Good morning. Thank you for calling APL. My name is [PII]. How may I help you?
[CUSTOMER][NEUTRAL] Hi, [PII]. Um, good morning. My name is uh [PII] from Fidelity Centers of New England. Um, I'd like to ask for assistance in verifying benefits and eligibility and see if we are in network for this patient.
[AGENT][NEUTRAL] OK, well, I can definitely help you with the eligibility, the benefits, and the network. And [PII], may I have a good contact number in case we're disconnected and the policy number?
[CUSTOMER][POSITIVE] Amazing.
[CUSTOMER][NEUTRAL] Oh, sure. Um, phone number is [PII], and that's a direct line.
[AGENT][POSITIVE] Thank you for that and the member's policy number, oh, I'm sorry.
[CUSTOMER][NEUTRAL] And then um
[CUSTOMER][NEUTRAL] Oh sorry, sorry. Yes, it's OK. Uh, well, the policy number, uh, she gave us is like, starts with letter D 433.
[AGENT][NEUTRAL] Hm.
[CUSTOMER][NEUTRAL] 02297.
[AGENT][NEUTRAL] OK, and do you have a copy of the member's ID card available?
[CUSTOMER][NEUTRAL] Um, she sent us, hold on a second, I think she had sent us.
[CUSTOMER][NEUTRAL] The back, the front.
[CUSTOMER][NEUTRAL] Let me
[CUSTOMER][NEUTRAL] And that real quick.
[CUSTOMER][NEUTRAL] You see that, yes, OK.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Oh sorry, one second, let me try to
[CUSTOMER][NEUTRAL] See where I do it.
[CUSTOMER][NEUTRAL] The emails were like
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] I think I have, oh, this policy number?
[AGENT][NEUTRAL] Does it start with
[CUSTOMER][NEUTRAL] Without the letter?
[AGENT][NEUTRAL] Yeah, does it, does it start with like a 01 or 02?
[CUSTOMER][NEUTRAL] Is that
[CUSTOMER][NEUTRAL] 02
[AGENT][NEUTRAL] OK, what's that number?
[CUSTOMER][NEUTRAL] Yeah, I have 02584586. So this like, this like the member ID?
[AGENT][POSITIVE] Thank you.
[AGENT][NEUTRAL] So that the number that you gave us for 90 degree benefits, that's a different company, so we can't use that um policy number, but the 02, that's our policy number.
[CUSTOMER][NEUTRAL] Oh, OK.
[CUSTOMER][NEUTRAL] OK, OK. All right.
[AGENT][NEUTRAL] Alright, I just need you to verify the member's first and last name and date of birth.
[CUSTOMER][NEUTRAL] Yeah, it is um
[CUSTOMER][NEUTRAL] Oh, her name. [PII].
[CUSTOMER][NEUTRAL] OK. [PII] and date of birth is
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] Thank you for that and all the information provided is a verification of benefits, not a guarantee of payment. So I am showing the policy is active. It's been effective since [PII].
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] And what type of benefits did you want to go over today?
[CUSTOMER][NEUTRAL] Yeah. Uh, so first, I would like to see if we are in network. And then the benefits that I'll be needing are like specialist office visit co-pay, and infertility.
[AGENT][NEUTRAL] OK, so this is a hospital indemnity policy, so it's a limited medical policy. The hospital indemnity portion of the policy does not require a network because it's just like a list of benefits and what would be paid towards it. However, there is the PPO network that is provided here through multi-plan. That is where the network comes into play.
[CUSTOMER][NEUTRAL] Uh-huh.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] Um, we also don't have access to their list of providers because they're a different company, but I can give you their phone number or website for you to check and see if you're in network.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] OK, right, we can do that. Um, what's the website?
[AGENT][NEUTRAL] So it's [PII].
[CUSTOMER][POSITIVE] OK, thank you. And um
[CUSTOMER][NEUTRAL] Sorry.
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Yes. So, uh, can you, so there is no co-pay for any office visit cause this is not a hospital, uh, benefit, it's mostly like office only.
[AGENT][NEUTRAL] Right, I understand. Um, so no, this policy doesn't have any copays. Um, it's not a major medical insurance. It just has the, um,
[CUSTOMER][NEUTRAL] Uh-huh.
[AGENT][NEUTRAL] You said specialist, yeah, it doesn't really have like any.
[AGENT][NEUTRAL] Office visits. Hold on one moment. Let me pull up the full breakdown. Hold on one second.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][POSITIVE] Yup. Thank you so much.
[AGENT][POSITIVE] You're welcome.
[AGENT][NEUTRAL] OK, so for office, um, under the outpatient sickness rider, the policy will pay up to $75 per visit with a max of 5 visits per calendar year.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] There is also a um wellness and diagnostic testing um benefit. So for any wellness exams, the policy would pay $75 per test, um, and for diagnostic testing, the policy would pay up to $250 per test.
[CUSTOMER][NEUTRAL] Very
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Uh-huh.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] In terms of like specifically for fertility, there is no coverage, but that would be used, that office visit, the $75 at 5 visits per year.
[AGENT][NEUTRAL] To be used.
[CUSTOMER][NEUTRAL] OK. So the $75 will uh be patient responsibility or the insurance will pay up to?
[AGENT][NEUTRAL] That's what we would, the policy would pay up to $75 per visit.
[CUSTOMER][NEUTRAL] Oh, OK. All right. And then,
[AGENT][NEUTRAL] With a max of 5 per year.
[CUSTOMER][NEUTRAL] 5 per year. So no uh infertility.
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] OK. And do you know where the uh benefits are being sent to?
[AGENT][NEUTRAL] Um, so it depends. Um, it would be sent to the provider most likely, um, if the providers filing the claim, this isn't like the secondary insurance that we will reimburse, so it will most likely be the um provider.
[AGENT][NEUTRAL] But in some cases, depending on what
[CUSTOMER][NEUTRAL] I mean, uh,
[AGENT][NEUTRAL] Go ahead.
[CUSTOMER][NEUTRAL] Yeah, I, I mean, uh, through the insurance, what, what address? Cause, uh, if it's multi-plan, uh, I'm still looking for the list of the, uh, providers, but
[AGENT][NEUTRAL] Are you asking where to file a claim?
[CUSTOMER][NEUTRAL] Yes, where we file the claim.
[AGENT][NEUTRAL] OK, our claims mailing address is [PII] actually, hold on one second.
[AGENT][NEUTRAL] Because this is a different policy.
[AGENT][NEUTRAL] [PII].
[AGENT][NEUTRAL] [PII]
[AGENT][NEUTRAL] [PII].
[AGENT][NEUTRAL] Zip code is 7, I'm sorry, [PII].
[CUSTOMER][NEUTRAL] 551
[CUSTOMER][NEUTRAL] Uh, 21. And, uh, sorry, what's the name? Uh, is it APL?
[AGENT][NEUTRAL] This is I am, well, that address is for IMA.
[CUSTOMER][NEUTRAL] IMA
[CUSTOMER][NEUTRAL] It stands for
[AGENT][NEUTRAL] Um, I don't believe that's an abbreviation. I think that's just the name of the company.
[CUSTOMER][NEUTRAL] Oh, just IMA. OK, OK. All right. Thank you. Um, I'm actually on the website. I'm not sure. Oh, here, find a provider. OK, I think I just have to type the name, see.
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Uh, multi-plan.
[CUSTOMER][NEUTRAL] BPO, I think it's still.
[CUSTOMER][NEUTRAL] Oh
[CUSTOMER][NEUTRAL] Search by name and zip code. OK. Well, I think that is all for now. Doesn't seem like she has a lot of coverage. Um.
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Sorry. Thank you so much, [PII]. Uh, would it be OK to get the initials, your last name and a call reference number just for documentation purposes?
[AGENT][NEUTRAL] Of course, um, first initial of my last name is [PII], and there's no call reference number, but you can use my name and [PII].
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][POSITIVE] All right. You're amazing. Thank you so much. I appreciate your help for today.
[AGENT][POSITIVE] Thank you, I mean you also and thanks for calling APL.
[AGENT][NEUTRAL] Bye-bye.
[CUSTOMER][POSITIVE] Thank you. Bye-bye.