AccountId: 011433970860
ContactId: 760a5ff4-becf-4943-bd34-edf7a2728068
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 276130 ms
Total Talk Time (AGENT): 125700 ms
Total Talk Time (CUSTOMER): 102222 ms
Interruptions: 0
Overall Sentiment: AGENT=1.4, CUSTOMER=0.2
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/03/31/760a5ff4-becf-4943-bd34-edf7a2728068_20250331T17:30_UTC.wav
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[AGENT][POSITIVE] Thank you for calling APL. My name is [PII]. How can I help you?
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] Oh hey, [PII]. My name is [PII]. Last name is [PII]. I'm just calling you on behalf of facility as I need to verify benefits for a member.
[AGENT][NEUTRAL] OK, [PII], what is your callback number?
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] What is the policy number please?
[CUSTOMER][NEUTRAL] Sure, just a second.
[CUSTOMER][NEUTRAL] Uh
[CUSTOMER][NEUTRAL] It's 023267-20.
[AGENT][NEUTRAL] OK, that was 023-267-20, is that correct?
[CUSTOMER][NEUTRAL] Yes.
[AGENT][POSITIVE] OK one moment thank you.
[AGENT][NEUTRAL] And [PII] verify the patient's name and date of birth.
[CUSTOMER][NEUTRAL] Sure.
[CUSTOMER][NEUTRAL] The patient's name is [PII]. Date of birth is [PII].
[AGENT][POSITIVE] Thank you very much for the information. You're calling to verify outpatient benefits for the member?
[CUSTOMER][NEUTRAL] Uh, yeah, outpatient offer benefits, MRI services.
[AGENT][NEUTRAL] Outpatient office benefits and what other services? I'm sorry.
[CUSTOMER][NEUTRAL] MRI.
[AGENT][NEUTRAL] Thank you. OK, please note verification of benefits provided does not guarantee payment. Uh, this number shows effective as of [PII]. Policy shows active. Um, this policy does not cover for an office visit.
[CUSTOMER][NEUTRAL] I
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] Will the MRI be done inside the doctor's office or a facility?
[CUSTOMER][NEUTRAL] I
[CUSTOMER][NEUTRAL] Doctor's office.
[AGENT][NEUTRAL] OK, please note verification of benefits provided does not guarantee payment. We pay up to $6600 for the calendar year.
[CUSTOMER][NEUTRAL] OK
[CUSTOMER][NEUTRAL] I
[CUSTOMER][NEUTRAL] For what, like a deductibles or out of pocket?
[AGENT][NEUTRAL] No, what we do is we help with the major medicals deductible, co-pay and co-insurance based on coverage. This particular policy does not cover for the office visit, but if there's an MRI or diagnostic testing inside the doctor's office relative to a sickness or an injury, we pay up to $6600.
[CUSTOMER][NEUTRAL] OK. May I know the plan type?
[AGENT][NEUTRAL] This is a supplemental medical policy.
[CUSTOMER][NEUTRAL] OK, just a second.
[CUSTOMER][NEUTRAL] OK, it's a supplemental policy. So as you are secondary, you just pay the remaining amount, right?
[AGENT][NEUTRAL] We pay what's covered based on coverage and we'll pay up to $6600 for the calendar year.
[CUSTOMER][NEUTRAL] Yeah, I just wanna know like the, the 66,006,600. So it comes under the deductibles or out of pocket.
[AGENT][NEUTRAL] That is the amount
[CUSTOMER][NEUTRAL] Or it's a general amount?
[AGENT][NEUTRAL] That is the amount that we will help with the major medicals deductible, co-pay and co-insurance based on coverage.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK. So that's in general amount, right?
[AGENT][NEUTRAL] I'm sorry, I don't understand the question, [PII].
[CUSTOMER][NEUTRAL] Uh, like the amount you're saying is 6600.
[AGENT][NEUTRAL] I'm sorry?
[AGENT][POSITIVE] Correct.
[CUSTOMER][NEUTRAL] Is it a general amount or it, or it comes under like deductibles or out of pocket? That's what I'm asking you.
[AGENT][NEUTRAL] OK
[AGENT][NEGATIVE] This policy does not have a deductible.
[AGENT][NEUTRAL] Co-pay or co-insurance.
[CUSTOMER][NEUTRAL] Uh-huh.
[AGENT][POSITIVE] However, we help with the major medical.
[CUSTOMER][NEUTRAL] OK. And out of pocket as well?
[CUSTOMER][NEUTRAL] OK, got it. Just wanna confirm out of pocket as well, right?
[AGENT][POSITIVE] Thank you.
[AGENT][NEUTRAL] We pay up to $6600 to help with the major medical.
[CUSTOMER][NEUTRAL] Yeah, yeah, but not a pocket as well, right? Is there any?
[AGENT][NEUTRAL] This policy does not have a deductible to meet.
[AGENT][NEUTRAL] Or other pocket.
[CUSTOMER][NEUTRAL] I'm not asking about you. I'm asking. OK, good. And as it is supplemental policy.
[CUSTOMER][NEUTRAL] Uh, there is no authoration required, right?
[AGENT][POSITIVE] That is correct.
[CUSTOMER][POSITIVE] Mm thank you for that.
[AGENT][POSITIVE] You're welcome. Anything else I can help you?
[CUSTOMER][NEUTRAL] And, may I know your last name first initial?
[AGENT][NEUTRAL] My last name initial is [PII]. We do not provide reference numbers, [PII]. You can use my name and today's date.
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] Yeah
[CUSTOMER][NEUTRAL] Sure.
[AGENT][NEUTRAL] OK.
[CUSTOMER][POSITIVE] OK. I will, yeah. Thank you so much, [PII]. That's it.
[AGENT][NEUTRAL] Anything else I can help you with?
[AGENT][POSITIVE] Oh, you're welcome, [PII], and thank you for calling APL. Have a good day. Thank you.
[CUSTOMER][NEUTRAL] You too.
[AGENT][NEUTRAL] Mm bye bye.