AccountId: 011433970860
ContactId: 79a34efd-3561-46dc-b536-440a98938c81
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 221399 ms
Total Talk Time (AGENT): 85199 ms
Total Talk Time (CUSTOMER): 101186 ms
Interruptions: 0
Overall Sentiment: AGENT=0.7, CUSTOMER=0.7
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/03/04/79a34efd-3561-46dc-b536-440a98938c81_20250304T16:32_UTC.wav
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[AGENT][NEUTRAL] Thank you for calling American Public Life. This is [PII]. How may I assist you?
[CUSTOMER][NEUTRAL] Hi, um, I'm calling from a doctor's office and I have just spoken with [PII] a few minutes ago about a patient's policy, and I have another question.
[AGENT][NEUTRAL] OK, may I have your name?
[CUSTOMER][NEUTRAL] Do I, did I
[CUSTOMER][NEUTRAL] Uh, [PII].
[AGENT][NEUTRAL] And [PII], may I have a callback number?
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] And may I have the policy number you're calling in regards to?
[CUSTOMER][NEUTRAL] 02444949 ML 8.
[AGENT][NEUTRAL] It's 02444949.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] ML 8.
[AGENT][NEUTRAL] And may I have the patient's name and date of birth?
[CUSTOMER][NEUTRAL] [PII] date of birth is [PII].
[AGENT][POSITIVE] And thank you so much [PII] for verifying the policy. How may I assist you?
[CUSTOMER][NEUTRAL] OK, so when I was speaking with [PII], she was saying that the patient has benefits $1000 maximum per day and that it would pay um after the major medical plan pays and um but then she said something about copays and that it doesn't cover copays and this patient's major medical plan for surgery is copays.
[CUSTOMER][NEUTRAL] So like she has a $100 surgery co-pay for the doctor and the $800 surgery co-pay for the facility.
[AGENT][NEUTRAL] Yeah
[CUSTOMER][NEUTRAL] Does this, does your plan pay anything if those are co-pays?
[AGENT][NEUTRAL] Is this for an outpatient, inpatient, or an office setting?
[CUSTOMER][NEUTRAL] Outpatient surgery.
[CUSTOMER][NEUTRAL] Mm.
[AGENT][NEUTRAL] OK, so in regards to this member's benefits, I'm gonna go ahead and give you the disclaimer as well. Verification of coverage does not guarantee the payment of the claim. This member for outpatient does have up to $1000 per calendar day. It will go towards the primary insurance deductible, co-insurance, or co-pay. This policy is for sickness and injury only. It will not cover any preventative or wellness.
[CUSTOMER][NEUTRAL] OK, and [PII] was telling me that it would not cover the copay for an office visit.
[CUSTOMER][NEUTRAL] Is that true?
[AGENT][NEUTRAL] The member only has the office procedure benefit rider for services rendered. If it's for the physician co-pay, it does not cover the physician co-pay.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] But for a surgery, it would cover the physician co-pay for an outpatient surgery.
[AGENT][NEUTRAL] For the outpatient, if it's rendered within an outpatient facility.
[CUSTOMER][NEUTRAL] Mhm, it does. OK, that is what I really needed and can I get a reference number?
[AGENT][NEUTRAL] Yes, the reference number will be my first name, [PII], which is spelled [PII], last initial [PII] [PII] today's date.
[CUSTOMER][POSITIVE] OK, thank you, [PII]. I appreciate it.
[AGENT][POSITIVE] You're welcome. Thank you for calling American Public Life. [PII], have a great day.
[CUSTOMER][POSITIVE] OK thank you bye bye.