AccountId: 011433970860
ContactId: 7dc06463-f5e6-409a-9d42-d8ce6fc6421e
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 257200 ms
Total Talk Time (AGENT): 114860 ms
Total Talk Time (CUSTOMER): 102439 ms
Interruptions: 0
Overall Sentiment: AGENT=1.4, CUSTOMER=0.4
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/05/08/7dc06463-f5e6-409a-9d42-d8ce6fc6421e_20250508T17:35_UTC.wav
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[AGENT][POSITIVE] Good morning. I'm sorry, good afternoon. Thank you for calling APL. My name is [PII]. How may I help you?
[CUSTOMER][NEUTRAL] Yes, hi, I need to check some benefits for this, um, gap insurance of a patient.
[AGENT][POSITIVE] OK, well, I'll be more than happy to help you with the benefits. May I have your name and a good contact number?
[CUSTOMER][NEUTRAL] Yeah, my name is [PII].
[CUSTOMER][NEUTRAL] And the phone number is [PII].
[AGENT][NEUTRAL] Thank you for that. And may I have the member's policy number?
[CUSTOMER][NEUTRAL] I have 02581433 ML 7.
[AGENT][NEUTRAL] Thank you, hold on one moment.
[CUSTOMER][NEUTRAL] Mm.
[AGENT][NEUTRAL] And can you verify the member's first and last name and date of birth?
[CUSTOMER][NEUTRAL] Uh, her name is, well, hold on, because this is the spouse that I have here one second.
[CUSTOMER][NEUTRAL] OK, her name is [PII]. Date of birth [PII].
[AGENT][NEUTRAL] Thank you for that and all the information provided is a verification of benefits, not a guarantee of payment. I am showing that the policy is active. It's been effective since [PII]. And what type of benefits did you want to go over today?
[CUSTOMER][NEUTRAL] You said [PII]?
[CUSTOMER][NEUTRAL] I mean [PII]?
[AGENT][POSITIVE] Yes, that's the day the policy became effective.
[CUSTOMER][NEUTRAL] OK, so let me see, I'm not, I, I am not 100% sure the reason. I mean she's going for an ultrasound, the regular menses, but I need to know you guys cover her deductible, correct or not?
[AGENT][NEUTRAL] Yes, we pay our policy pays um towards the copay, deductible and co-insurance of coverage charges after primary, um, for outpatient, the benefit is up to $250 per day.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] OK, but that's, that's for a patient like if she goes to the hospital. What about in, in office ultrasound?
[AGENT][NEUTRAL] That's not how this policy works. This policy is broken down into inpatient and outpatient. So anything that is not admitted to the the hospital is outpatient, and that is where the office visits are under. So it will be $250 per day. There's no coverage for the office setting, but they do have the office treatment rider, so the treatment in the office could be covered up to that $250 per day.
[CUSTOMER][NEUTRAL] OK, but so you cannot tell me if you guys would pay her ultrasound? Can I give you a call and you can see if those calls are covered in office?
[AGENT][NEUTRAL] There's no need for the code. We go by the facility.
[AGENT][NEUTRAL] If it's not an admission into the hospital, it's outpatient, and that benefit is $250 per day for this policy.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] OK, and you said you cover the copay too or just the deductible and coinsurance?
[AGENT][NEUTRAL] I'm sorry, you sound really far away now. Can you repeat that for me?
[CUSTOMER][NEUTRAL] OK, that 250 covers only deductible and coin insurance or co-pay as well?
[AGENT][NEUTRAL] We pay towards the copay, deductible and co-insurance of covered charges after primary.
[CUSTOMER][NEUTRAL] OK, and what about if the primary didn't cover anything?
[CUSTOMER][NEUTRAL] You will cover 250, right?
[AGENT][NEUTRAL] If the primary does not apply, if primary does not apply, we cannot apply because we're second to them.
[CUSTOMER][NEUTRAL] No, when I say they apply, what about they apply deductible, so obviously you will cover it.
[CUSTOMER][NEUTRAL] Whatever they didn't pay because they applied the doctor.
[AGENT][NEUTRAL] The primary is not going to, the primary charge is the deductible or the co-pay, we help pay it.
[CUSTOMER][POSITIVE] Correct.
[CUSTOMER][NEUTRAL] OK, so let me have your name and a reference number for the call.
[AGENT][NEUTRAL] My name is [PII] 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][POSITIVE] Thank you.
[AGENT][POSITIVE] You're welcome