AccountId: 011433970860
ContactId: 83869fdb-ad6a-4e9f-acaa-c2e9c0a4ffcc
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 286309 ms
Total Talk Time (AGENT): 135195 ms
Total Talk Time (CUSTOMER): 80760 ms
Interruptions: 1
Overall Sentiment: AGENT=1.4, CUSTOMER=0.2
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/06/04/83869fdb-ad6a-4e9f-acaa-c2e9c0a4ffcc_20250604T16:32_UTC.wav
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[AGENT][NEUTRAL] Thank you for calling APL. This is [PII]. How can I help you?
[CUSTOMER][NEUTRAL] Yes, hi [PII]. I'm calling from Doctor [PII]'s office, and I need benefits on a patient, but I don't have the patient. The patient didn't provides us with the correct ID number.
[AGENT][POSITIVE] OK, I can help you with.
[CUSTOMER][NEUTRAL] It's only 4 numbers. It looks like more like a group number.
[AGENT][POSITIVE] Yeah, that sounds like a group number. Um, I can help you with benefits though. Um, can I get your name and a callback number in case we get disconnected?
[CUSTOMER][NEUTRAL] Um, my name is [PII]. Callback number is [PII].
[AGENT][POSITIVE] OK, thank you so much, [PII]. And do you have their social security number by chance?
[CUSTOMER][NEUTRAL] Welcome.
[CUSTOMER][NEUTRAL] Um, I do [PII].
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] I can look them up that way.
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] Mm
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] Yeah.
[AGENT][NEUTRAL] Can you verify his date of birth for me, please?
[CUSTOMER][NEUTRAL] [PII].
[AGENT][POSITIVE] OK, thank you so much.
[AGENT][NEUTRAL] I mean, you said you're a dental provider?
[CUSTOMER][NEUTRAL] No medical.
[AGENT][POSITIVE] OK, I'm sorry.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] OK, because it looks like he has 2.
[AGENT][NEUTRAL] Policies with us, um, this one is our Medlink policy. Um, are you ready for the policy number?
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] OK, 02.
[AGENT][NEUTRAL] 41
[AGENT][NEUTRAL] 931 8.
[AGENT][NEUTRAL] And
[CUSTOMER][NEUTRAL] That's 02419318?
[AGENT][NEUTRAL] Yes, ma'am, and this policy is active with an effective date of [PII]. This policy is secondary gap insurance, um, which helps pay for co-pay, co-deductible, and co-insurance. Um, and when filing a claim for this policy, we will need the primary insurance um explanation of benefits showing that some, OK.
[CUSTOMER][NEUTRAL] OK
[CUSTOMER][NEUTRAL] Right, so do you pick up.
[AGENT][NEUTRAL] Go ahead.
[CUSTOMER][NEUTRAL] Like, do you cover procedures that are rendered in the office because the patient has a deductible with the primary plan. Any procedures rendered in the doctor's office will be the patient's responsibility. So does this gap plan cover procedures in the office?
[AGENT][NEUTRAL] Let me go ahead and pull up this policy and check.
[AGENT][NEUTRAL] So would that be um outpatient services I take it?
[CUSTOMER][NEUTRAL] Yes, done in the doctor's office, like office surgery.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] OK, and this is just a verification of benefits, not a guarantee of payment. He does have an outpatient benefit maximum of up to $7350 per calendar year.
[AGENT][NEUTRAL] With a $0 outpatient deductible and emergency room deductible.
[AGENT][NEUTRAL] I am showing that surgery in a hospital facility or freestanding outpatient surgery center is covered.
[AGENT][NEUTRAL] Um, but you said it was in a physician's office?
[CUSTOMER][NEUTRAL] Yes, in a specialist office does he have an office, um, I'm not asking for the copay for the office visit for the procedure reed in the office, would he have benefits for procedures rendered in the doctor's office?
[AGENT][NEUTRAL] I am showing he has an office treatment writer. Let me check.
[CUSTOMER][NEUTRAL] OK, so if he has an office treatment writer then he would have benefits in the doctor's office.
[AGENT][POSITIVE] Yes ma'am, it will go towards that. um, we will pay the out of pocket amount for physician covered charges.
[CUSTOMER][NEUTRAL] OK, so may I have a reference number for the call?
[AGENT][NEUTRAL] So we don't have reference numbers, but you can use my name and last initial in today's date, um, [PII] in today's date.
[CUSTOMER][NEUTRAL] A
[CUSTOMER][NEUTRAL] OK, so it's [PII] and today's date. Alright, thank you.
[AGENT][NEUTRAL] Yes, ma'am. OK, is there anything else I can help you with?
[CUSTOMER][NEUTRAL] OK bye bye.
[AGENT][POSITIVE] Have a great day, [PII]. OK, bye.
[CUSTOMER][POSITIVE] No, that's all thank you you too bye bye.