AccountId: 011433970860
ContactId: 833d3430-5e70-4c34-861d-085fec3dba03
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 304609 ms
Total Talk Time (AGENT): 147318 ms
Total Talk Time (CUSTOMER): 86032 ms
Interruptions: 0
Overall Sentiment: AGENT=1.2, CUSTOMER=0.2
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/01/14/833d3430-5e70-4c34-861d-085fec3dba03_20250114T15:07_UTC.wav
--------------------------------------------
[AGENT][POSITIVE] Hey, good morning and thanks for calling APL. This is [PII]. How can I help you today?
[CUSTOMER][NEUTRAL] Um, hi, good day. This is [PII] from provider's office. I'm just calling to check for benefits and eligibility for the patients I have here.
[AGENT][POSITIVE] OK, yeah, I'd love to help you with some benefits and eligibility today, Ms. [PII], and.
[AGENT][NEUTRAL] Do you mind if I go ahead and get a good callback number from you real quick?
[CUSTOMER][NEUTRAL] Uh, for my callback number, it is [PII].
[AGENT][POSITIVE] Thank you so much. And the policy number for your patient?
[CUSTOMER][NEUTRAL] Um
[CUSTOMER][NEUTRAL] One moment. For the patient I have here, it is 1477504 M L as in Lima, 8.
[AGENT][NEUTRAL] Perfect. And give me a moment to get that policy pulled up for you, my friend. Would you be able to verify for me your patient's first and last name and date of birth?
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Um, date of birth of the patient, um, this is [PII].
[AGENT][NEUTRAL] Perfect and their first and last name?
[CUSTOMER][NEUTRAL] This is for [PII].
[AGENT][POSITIVE] Perfect, thank you so much. I really appreciate that and your patient is current and active. It looks like her effective date is [PII].
[AGENT][NEUTRAL] And then are you looking for inpatient or outpatient benefits today?
[CUSTOMER][NEUTRAL] Uh, for, uh, outpatient for office visit?
[AGENT][NEUTRAL] OK, perfect. Let me get those benefits pulled up. I do wanna let you know any benefit information I give you over the phone is just a verification of coverage and never guarantee a payment.
[CUSTOMER][NEUTRAL] S.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] It looks like your patient has with us an outpatient um calendar year maximum of $1000.
[AGENT][NEUTRAL] And it does look like she has an office treatment rider on this policy.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] And then is there any other information you're needing today?
[CUSTOMER][NEUTRAL] Um, on, uh, one moment, let me just check.
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Um, is there any term date for this, um, policy?
[AGENT][NEUTRAL] No, the policy is active so it doesn't have a term date.
[CUSTOMER][NEUTRAL] So, uh, the original, um, eligibility is [PII], right? Just to verify?
[AGENT][NEUTRAL] Um, I think it was [PII], but let me go back to their effective date. [PII]. I'm sorry.
[CUSTOMER][NEUTRAL] Oh, OK.
[CUSTOMER][NEUTRAL] And can you uh verify as well if uh the office visit is covered for this plan?
[AGENT][NEUTRAL] Unfortunately I can't um tell you anything is like fully covered or not covered until there's a claim. Um they do have outpatient benefits and they do have treatments in an office setting.
[CUSTOMER][NEUTRAL] It is like
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] Um, but it's really gonna depend on how their major medical pays because we're their secondary insurance.
[CUSTOMER][NEUTRAL] Oh, OK. So, we'll just based on the maximum uh coverage, right? It's the $1000 only.
[AGENT][NEUTRAL] Yeah, it's
[AGENT][NEUTRAL] Yeah, and then everything else is really gonna come down to the claim form, what procedures were done, were they covered, what major medical decided was applied to co-pay, co-insurance and deductible, and the location of, I mean, obviously it's in an office, but it's all gonna come down to that, that information, um, as far as what we're able to cover or not, and that's why we can't, we can't really tell you without all of that on hand.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Um, can I ask, uh, for the plan type of this?
[AGENT][NEUTRAL] Oh yeah, we're like do you want like the name of the plan or do you want me to explain like what type of plan it is?
[CUSTOMER][NEUTRAL] Um, just the name of the plan.
[AGENT][NEUTRAL] The name of the plan is [PII]
[CUSTOMER][NEUTRAL] Mhm. And we just have a reference number for the call, and can you spell your name for me?
[AGENT][NEUTRAL] Oh yeah, you betcha. It's my um I cannot talk. I'm sorry. I was about to say it's my name. My name is [PII] and the last initial [PII].
[CUSTOMER][NEUTRAL] Mhm. And the reference number?
[AGENT][NEUTRAL] The reference number is just my name and today's date.
[CUSTOMER][POSITIVE] Mhm. OK. Thank you very much. Uh, you have a great day. Thank you. Thank you.
[AGENT][POSITIVE] Hey you too thank you so much [PII] take care.
[CUSTOMER][NEUTRAL] Mhm
[AGENT][NEUTRAL] Bye bye.