AccountId: 011433970860
ContactId: 749d6b60-78d1-4aa3-bc3b-16bdc22718d1
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 576159 ms
Total Talk Time (AGENT): 253964 ms
Total Talk Time (CUSTOMER): 210554 ms
Interruptions: 3
Overall Sentiment: AGENT=1, CUSTOMER=0.3
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/02/20/749d6b60-78d1-4aa3-bc3b-16bdc22718d1_20250220T17:02_UTC.wav
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[AGENT][POSITIVE] Good morning. Thank you for calling APL. This is [PII]. How can I help you?
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] Hey, [PII]. My name is [PII].
[CUSTOMER][NEUTRAL] Uh, actually, I need a PCP office visit benefits and I have a 6 CPD code.
[AGENT][NEUTRAL] OK, [PII], you're needing to see if office visits are covered under a member's policy. Is that correct?
[CUSTOMER][NEUTRAL] So
[CUSTOMER][NEUTRAL] They
[CUSTOMER][NEUTRAL] Sorry?
[AGENT][NEUTRAL] I'm sorry, there's something in the background that is very loud, [PII], and I can barely hear you.
[CUSTOMER][POSITIVE] Yeah, yeah, yeah. Sorry for that.
[CUSTOMER][NEUTRAL] Uh, can you hear me now?
[AGENT][NEUTRAL] That is better. Did you say that you're needing benefits for an office visit? Is that correct?
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Yes.
[AGENT][POSITIVE] Yes, I can help you with that, [PII]. And what is your callback number, please?
[CUSTOMER][NEUTRAL] It
[CUSTOMER][NEUTRAL] Yeah, the callback number is [PII] is a direct line.
[AGENT][NEUTRAL] OK, one more time, [PII]. [PII].
[CUSTOMER][NEUTRAL] [PII]. It's a direct line.
[AGENT][NEUTRAL] Thank you. And what is the member's policy number please, [PII]?
[CUSTOMER][NEUTRAL] The policy number I see here, D as in Delta 43731661.
[AGENT][NEUTRAL] OK, [PII], thank you, but that is not an APL policy number, that is a 90 degree benefit number. Do you have another number for the member?
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Uh, I don't have that. Let me check that I have a social security number or not. Just a second.
[AGENT][NEUTRAL] Do you
[AGENT][POSITIVE] OK, thank you.
[CUSTOMER][NEUTRAL] I have the Social Security number. Do you need?
[AGENT][NEUTRAL] Uh yes, please.
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] Again, the social is [PII]. Is that correct?
[CUSTOMER][NEUTRAL] Yeah, yeah. [PII].
[AGENT][POSITIVE] OK, and this, OK, thank you.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] And [PII], the information that I provide today will be a verification of benefits and not not a guarantee of payment. What is your patient's name and date of birth?
[CUSTOMER][NEUTRAL] Mhm
[CUSTOMER][NEUTRAL] Oh
[CUSTOMER][NEUTRAL] The name is [PII]. Date of birth is [PII].
[AGENT][POSITIVE] OK, thank you.
[CUSTOMER][NEUTRAL] Right and
[AGENT][NEUTRAL] OK, [PII], so she is the policy holder on this limited benefit plan and it is active with an effective date of [PII].
[AGENT][NEUTRAL] And [PII], if you'll give me just one moment to get her benefit information pulled up, I had to reopen one of my parts of my system, so please bear with me just a moment. Thank you.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] 93922 and 9225.
[AGENT][POSITIVE] Thank you for your patience, ma'am, while this is still opening.
[CUSTOMER][NEUTRAL] Uh hello, ma'am.
[AGENT][NEUTRAL] I am still here, [PII]. I'm waiting on my information to load.
[CUSTOMER][NEUTRAL] OK. And, and can I also provide you the CCD codes?
[AGENT][NEUTRAL] No, sir.
[AGENT][NEUTRAL] I don't need this. I'll be able to give you the benefit information for an office visit. This is not a major medical insurance plan. This is a limited benefit plan and on this policy, I'm pulling up her benefits, so just a moment.
[CUSTOMER][NEUTRAL] I don't
[CUSTOMER][NEUTRAL] So
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] So it's a limited plan.
[AGENT][NEUTRAL] So she has, she has a maximum benefit per visit of $75 and a max of 5 visits per calendar year per covered person.
[CUSTOMER][NEUTRAL] But yeah.
[CUSTOMER][NEUTRAL] How, how many visitors left?
[AGENT][NEUTRAL] Just one moment.
[AGENT][NEUTRAL] As of now, she has not used any for this calendar year.
[CUSTOMER][NEUTRAL] Uh, so all 5 visit is left. OK.
[AGENT][NEUTRAL] And once
[AGENT][NEUTRAL] That is correct and yes sir, once the claim has been processed through APL, we do have a portal saying that you can check our claim status and you should also be able to access our explanation of benefits and the website to go to for that is going to be secured. [PII].
[CUSTOMER][NEUTRAL] OK. So, uh, basically, uh, I have a description for the CBD code. Do you need it for that?
[AGENT][NEUTRAL] I do not. Office visits. Again, I've given you the benefit information for an office visit.
[CUSTOMER][NEUTRAL] Oh OK.
[CUSTOMER][NEUTRAL] Yeah
[CUSTOMER][NEUTRAL] So I got the office but it's a $75 copay, uh, it is a copay amount, $75 or a maximum amount?
[AGENT][NEUTRAL] No, sir, that is, no, so that is the maximum benefit amount up to $75 per visit. This is not a major medical insurance plan.
[CUSTOMER][NEUTRAL] OK, I got it.
[CUSTOMER][NEUTRAL] OK, I got it. So, basically, it's a limited plan.
[AGENT][NEUTRAL] I'm sorry, what was your question?
[CUSTOMER][NEUTRAL] Is there a limited, limited plan, right?
[AGENT][POSITIVE] Yes, it is. That is correct.
[CUSTOMER][NEUTRAL] OK. And uh what is the correct uh policy number? It means the ID number, patient ID number you have. Please give me.
[AGENT][NEUTRAL] 02
[AGENT][NEUTRAL] Mhm. Are you ready?
[CUSTOMER][POSITIVE] Yeah, I'm ready.
[AGENT][NEUTRAL] 02537911.
[CUSTOMER][NEUTRAL] And uh what is the group number for this patient, correct group number?
[AGENT][NEUTRAL] The group number is 70056.
[CUSTOMER][NEUTRAL] So 70056.
[AGENT][POSITIVE] Correct.
[CUSTOMER][NEUTRAL] And what's the insurance name for this insurance company name?
[AGENT][NEUTRAL] The name of our insurance company is American Public Life.
[CUSTOMER][NEUTRAL] OK, I can write down here. American.
[CUSTOMER][NEUTRAL] Public life.
[CUSTOMER][NEUTRAL] OK. Because my systems.
[AGENT][NEUTRAL] APL.
[CUSTOMER][NEUTRAL] Yeah, because my system is showing me it's a 90-degree benefits, multi-plan employer group plan. Is it right?
[AGENT][NEUTRAL] Yes.
[CUSTOMER][NEUTRAL] So 90 degree benefit is right or American public life is right? Which one is?
[AGENT][NEUTRAL] American Public Life is the name of my company.
[AGENT][NEUTRAL] That I work for.
[CUSTOMER][NEUTRAL] And the 90 degrees.
[AGENT][NEUTRAL] 90 degree benefits would be the company that for the other number, the D number that you have.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] They may, they apparently, she also has a plan with them.
[CUSTOMER][NEUTRAL] And
[CUSTOMER][NEUTRAL] OK. So, if uh the American public life and the 9 degrees, so it means is a part of that, right?
[AGENT][NEUTRAL] This is a separate, this is a separate policy from the one with the D number. Yes, sir.
[CUSTOMER][NEUTRAL] So, sir, if
[CUSTOMER][NEUTRAL] OK, sir.
[CUSTOMER][NEUTRAL] So I can write down here in 90, I can remove the 90 degree and, and write down your American public life, right?
[CUSTOMER][NEUTRAL] 5897
[AGENT][NEUTRAL] Yeah, OK.
[AGENT][NEUTRAL] You would have to, that's two separate companies. The the D number goes to.
[CUSTOMER][NEUTRAL] But
[AGENT][NEUTRAL] A different company that is for 90 degree benefits. The policy number that I gave you is her policy number for APL for American Public Life.
[CUSTOMER][NEUTRAL] On the 90 days.
[CUSTOMER][NEUTRAL] OK, so it's a different company 93 and this is a different company. OK. So then now the, uh, I uploaded the incorrect, I think so, OK. And it's active it's a limited policy.
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] And uh
[AGENT][NEUTRAL] I'm
[CUSTOMER][NEUTRAL] Give me a moment.
[CUSTOMER][NEUTRAL] And is your calendar a plan here?
[AGENT][NEUTRAL] This is a calendar year as I explained it's 5 visits per calendar year.
[CUSTOMER][NEUTRAL] And it's a PPO policy, right?
[AGENT][NEUTRAL] Pardon me?
[CUSTOMER][NEUTRAL] Is it a PPO policy, right?
[AGENT][NEUTRAL] Right, so this is a limited benefit plan.
[CUSTOMER][NEUTRAL] OK. And what can you provide me the reference number?
[AGENT][NEUTRAL] We are not major medical insurance.
[AGENT][NEUTRAL] I'm sorry, [PII], what was your question?
[CUSTOMER][NEUTRAL] Can you provide me the uh reference number now?
[AGENT][NEUTRAL] You would use my name that I gave you along with today's date.
[CUSTOMER][NEUTRAL] Can you spell it?
[AGENT][NEUTRAL] [PII].
[CUSTOMER][NEUTRAL] [PII]
[AGENT][NEUTRAL] [PII]
[CUSTOMER][NEUTRAL] Hi.
[AGENT][POSITIVE] That is correct.
[CUSTOMER][NEUTRAL] [PII]. OK.
[AGENT][NEUTRAL] [PII]
[CUSTOMER][POSITIVE] Yeah, that's I only. OK. And in today's date. Thank you for that.
[AGENT][POSITIVE] That is correct. You're welcome and is there anything else I can help you with today?
[CUSTOMER][POSITIVE] No, thank you. So, thank you. Have a nice day. Bye-bye.
[AGENT][POSITIVE] I do, yes, sir, you too, and thank you again for calling APL.
[CUSTOMER][NEUTRAL] Yeah
[CUSTOMER][NEUTRAL] [PII]