AccountId: 011433970860
ContactId: 7d504db4-0f54-43d4-98dc-e691518e7016
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 216160 ms
Total Talk Time (AGENT): 85497 ms
Total Talk Time (CUSTOMER): 116172 ms
Interruptions: 1
Overall Sentiment: AGENT=0.3, CUSTOMER=1.2
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/03/07/7d504db4-0f54-43d4-98dc-e691518e7016_20250307T20:00_UTC.wav
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[AGENT][NEUTRAL] Thank you for calling APL. This is [PII]. How can I help you?
[CUSTOMER][NEUTRAL] Hi, good afternoon, [PII]. This is [PII]. I'm calling from Florida Gulf Coast ENT. Would you be able to assist with eligibility and benefits please for one of our patients?
[AGENT][NEUTRAL] Of course I can check eligibility and benefits for you. I'm sorry, you said your name was [PII]?
[CUSTOMER][POSITIVE] Yes, with an [PII], correct.
[AGENT][NEUTRAL] OK and then can I get a good call back number from you in case we're disconnected?
[CUSTOMER][NEUTRAL] Sure it's [PII] and then my extension is [PII] or [PII].
[AGENT][NEUTRAL] Got it, thank you. uh, do you have that policy number?
[CUSTOMER][NEUTRAL] Yes, so, uh, we have on file 230,070.
[CUSTOMER][NEUTRAL] 8, M as in Mike, L as in Lima, and then 8.
[AGENT][NEUTRAL] OK, and uh what was the name and date of birth for the insured please?
[CUSTOMER][NEUTRAL] Alright, this is for [PII] and the date of birth is [PII].
[AGENT][NEUTRAL] Perfect, thank you for verifying that. Uh, so this policy is active. Effective date was [PII], and this is a secondary medical policy, so it is designed to help with co-pay, deductible and co-insurance after major medical pays, and we really need to look at the inpatient or outpatient benefits.
[CUSTOMER][NEUTRAL] Alright, if you could just um pull out the benefits for specialist office visit please or for CPT 99214 thank you.
[AGENT][NEUTRAL] Sure, OK. Of course, um, so, um, of course, I will let you know verification of coverage is not a guarantee of payment for claims. So for this policy, uh, office visits and treatment received in office is not going to be covered.
[CUSTOMER][NEUTRAL] I see. So, um, office visit or is it just for a specialist or any office visit won't be covered?
[AGENT][NEUTRAL] It's any physician's office, right.
[CUSTOMER][NEUTRAL] Oh, OK dokey. Any physicians visit won't be covered. All righty. Thank you for confirming that. So, um, I, all right, so,
[AGENT][NEUTRAL] Of course.
[CUSTOMER][NEUTRAL] Yeah, because it's so it wasn't noted before or or did, did this plan change previously because it was in the note before um.
[AGENT][NEUTRAL] Um,
[AGENT][NEGATIVE] I shouldn't have as this one was effective since the beginning of [PII].
[CUSTOMER][NEUTRAL] Oh, I see. So maybe it was just, all right, sorry, it was just noted wrong. Mhm.
[AGENT][NEUTRAL] Yes.
[AGENT][NEUTRAL] The only office treatment that would be can uh uh covered would be if it's regarding uh cancer treatment.
[CUSTOMER][NEUTRAL] Mhm
[CUSTOMER][NEUTRAL] All right, will be CA treatment. OK dokey, because this patient has a follow up, um, visit for sleep study review, um, on the [PII]. All righty. So let me just repeat that, [PII]. So this plan only covers, um, if it's gonna be office visit, only, um, cancer treatment would be covered and then the specialist, specialist office visit or any physicians visit won't be covered under this plan, correct?
[AGENT][NEUTRAL] Mhm.
[AGENT][POSITIVE] Correct.
[CUSTOMER][NEUTRAL] OK dokey thank you [PII] and then um one last thing if you could also um share the initial to your last name and a reference number just for our records please.
[AGENT][NEUTRAL] Of course. Uh, so my, uh, the reference number would just be my first name, last initial, and today's date. And so my name is spelled [PII]
[AGENT][NEUTRAL] And was there anything else I could help you with?
[CUSTOMER][POSITIVE] Uh, that's all, [PII]. Thank you so much for your help and you have a good rest of your day.
[AGENT][NEUTRAL] Of course.
[AGENT][POSITIVE] Thank you. Thanks for calling APL. Have a great rest of your day as well. Bye bye.
[CUSTOMER][POSITIVE] Alright thank you bye.