AccountId: 011433970860
ContactId: 7c3f1858-d06f-41b6-a9f1-d575d2791921
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 311799 ms
Total Talk Time (AGENT): 137908 ms
Total Talk Time (CUSTOMER): 147613 ms
Interruptions: 0
Overall Sentiment: AGENT=1.3, CUSTOMER=1.6
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/02/04/7c3f1858-d06f-41b6-a9f1-d575d2791921_20250204T13:42_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] Hello, [PII]. This is [PII]. I am calling from Cedar Park Surgeons and I would need to check some benefits for a patient, please.
[AGENT][POSITIVE] OK, I'll be more than happy to help you with the benefits. The line is kind of choppy. I didn't get your name and the, if you, I think you said where you were calling from.
[CUSTOMER][NEUTRAL] Do
[CUSTOMER][NEUTRAL] Uh yes. Uh, I'm going to spell my name. It's [PII] of my last name is [PII]. I am calling from Cedar Park Surgeons on behalf of Doctor [PII].
[AGENT][NEUTRAL] OK, and what's a good contact number for you in case we're disconnected and then the policy number?
[CUSTOMER][POSITIVE] Thank you. It's [PII].
[CUSTOMER][NEUTRAL] [PII]
[CUSTOMER][NEUTRAL] 344 4
[CUSTOMER][NEUTRAL] And I do have
[CUSTOMER][NEUTRAL] ID number 0175.
[CUSTOMER][NEUTRAL] 8742.
[AGENT][NEUTRAL] Thank you, hold on one moment.
[CUSTOMER][POSITIVE] Yes, you're welcome.
[AGENT][NEUTRAL] And can you verify the member's first and last name and date of birth?
[CUSTOMER][NEUTRAL] Uh yes, I have [PII] Order. Date of birth is [PII].
[AGENT][NEUTRAL] Thank you for that and all the information provided is a verification of benefits, not a guarantee of payment. And I am showing the policy is active. It's been effective since [PII]. And what type of benefits did you want to go over today?
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][POSITIVE] Uh, thank you so much for your patience. I would need to check the general benefits, please. Um,
[CUSTOMER][NEUTRAL] Uh, I don't know if this plan is like supplemental. I don't know how it works because it's the first time I do this insurance. Yes.
[AGENT][NEUTRAL] General
[AGENT][NEUTRAL] When you say general benefits, are are you considered outpatient or inpatient?
[CUSTOMER][NEUTRAL] Uh, can you please check for outpatient surgery? And I would also need to know if there is any co-pay for an office visit with the specialist, please.
[AGENT][NEUTRAL] OK, so this is their secondary insurance. So we don't apply co-pays or deductibles, we help pay that. So we pay towards co-pays, deductible and co-insurance after primary. For outpatient, the benefit is up to $1000 per calendar year.
[CUSTOMER][NEUTRAL] Yeah.
[AGENT][NEUTRAL] There is no coverage for the in-office setting if you're charging for like a facility charge, but they do have the office treatment rider. So any treatment as long as it's not cosmetic, should be covered under the policy up to the $1000 per calendar year.
[AGENT][NEUTRAL] Did you want me to see if any has been used for 2025?
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Um, yes, please. Can you please check that for me?
[AGENT][NEUTRAL] Sure, hold on one moment.
[AGENT][NEUTRAL] So there has been no benefits used for 2025, so she still has that $4000 for the year.
[CUSTOMER][POSITIVE] Thank you.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] OK. OK. Thank you so much. So, uh, the $1000 per calendar year, it applies only for the outpatient or also for the office visit?
[AGENT][NEUTRAL] For her, OK, so her policy is broken down into inpatient and outpatient. So unless it's hospital admission and confinement, everything else will be outpatient. There's no specific benefit for office visits. There is the office treatment rider, which covers the treat which should cover the treatment in the office, um, the facility charge would most likely be denied because there's no place of service coverage.
[CUSTOMER][NEUTRAL] Uh-huh.
[CUSTOMER][NEUTRAL] Uh-huh.
[CUSTOMER][NEUTRAL] OK. OK. So the office visit, it will be considered as an outpatient service.
[AGENT][NEUTRAL] Yes, because it's not in hospital on this policy.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][POSITIVE] OK. Got it. Thank you so much. And um if there's any coinsurance on the primary plan that doesn't
[CUSTOMER][NEUTRAL] Does it apply to the coinsurance, I mean, or to the co-pay?
[AGENT][NEUTRAL] We
[AGENT][NEUTRAL] We pay towards the copay, the deductible and co-insurance of covered charges after primary.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][POSITIVE] Uh insurance. OK, that's perfect. Thank you so, so much. I appreciate it. Uh, may I have please initial of your last name and a call reference, [PII]?
[AGENT][NEUTRAL] Sure, so the first initial to my last name is [PII]. There's no call reference number, but you can use my name and today's date.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][POSITIVE] Mhm. OK, perfect. Thank you so, so much, and uh, I do wish you a wonderful day ahead.
[AGENT][POSITIVE] You also, and thanks for calling APL [PII]. Was there anything else I could assist you with today?
[CUSTOMER][POSITIVE] No, this is all I needed. Thank you so, so much.
[AGENT][POSITIVE] You're welcome thanks for calling APL have a great week.
[CUSTOMER][POSITIVE] Thank you, bye bye.
[AGENT][NEUTRAL] But