AccountId: 011433970860
ContactId: 8231685f-3ff4-4854-9cd7-aa015f988247
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 143520 ms
Total Talk Time (AGENT): 80191 ms
Total Talk Time (CUSTOMER): 56241 ms
Interruptions: 1
Overall Sentiment: AGENT=0.9, CUSTOMER=0.4
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/05/06/8231685f-3ff4-4854-9cd7-aa015f988247_20250506T14:46_UTC.wav
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[AGENT][NEUTRAL] Calling APL, this is [PII]. How may I assist you?
[CUSTOMER][NEUTRAL] Yes, hi, I'm calling from Doctor [PII]'s office. I need to go over benefits on a patient, please.
[AGENT][POSITIVE] Sure, I can assist you with that. Can I have your name and a callback number?
[CUSTOMER][NEUTRAL] Um, my name is [PII], and the callback number is [PII].
[AGENT][NEUTRAL] Thank you [PII]. What is the policy number of the member that you're calling to verify benefits for?
[CUSTOMER][NEUTRAL] 02255683 ML 8
[AGENT][NEUTRAL] Can you verify the patient's name and date of birth?
[CUSTOMER][NEUTRAL] [PII] and that's [PII].
[AGENT][POSITIVE] Thank you, [PII].
[AGENT][NEUTRAL] This policy has been active since [PII] and it's currently active. You're calling to verify benefits for outpatient inpatient office visits.
[CUSTOMER][NEUTRAL] OK
[CUSTOMER][NEUTRAL] Outpatient for not for office visits this uh office visits are usually not covered with gap plans. Patient has a deductible with her primary plan. Any procedures rendered in the office, I need to know if this gap plan will cover that.
[AGENT][NEUTRAL] No, no procedures rendered in the office is covered under the policy. The policy only covers outpatient, meaning as in diagnostic testing, physical therapy, urgent care, emergency room, anything considered as outpatient setting.
[AGENT][NEUTRAL] Or inpatient.
[CUSTOMER][NEUTRAL] Right, but, um, outpatient would also outpatient would also be the office.
[AGENT][NEUTRAL] No, ma'am, that would not be considered as a.
[CUSTOMER][NEUTRAL] This is a specialist office.
[AGENT][MIXED] Correct, but still the place of service will be 11. Would it be [PII], 23, 19?
[CUSTOMER][NEUTRAL] What what is that? [PII], 23, 19 no place your service is 1111.
[AGENT][NEUTRAL] Place of service.
[AGENT][NEUTRAL] So that'll be considered as an office visit and office visits are not covered, the office visit or the treatment received in the office.
[CUSTOMER][NEUTRAL] It's not an office visit. I'm talking about the treatment received in the office.
[AGENT][NEUTRAL] Right, I get that. I understand that, Rose. However, it is not covered under the policy. The policy does not have a treatment rider for treatment received in the office. It's not covered under the policy.
[CUSTOMER][NEUTRAL] Alright, so then let me have a reference number that the patient does not have benefits for treatments rendered in the office.
[AGENT][NEUTRAL] We don't provide reference numbers. However, you can use my name which is [PII], and today's date is a reference because unfortunately we don't provide reference numbers. Thanks for calling APL and have a great day.
[CUSTOMER][NEUTRAL] [PII]
[AGENT][POSITIVE] Yes, that is correct.
[CUSTOMER][POSITIVE] You too thank you bye.
[AGENT][NEUTRAL] Bye.