AccountId: 011433970860
ContactId: 857cf69e-d815-4450-a673-bd1886dfe955
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 180440 ms
Total Talk Time (AGENT): 81136 ms
Total Talk Time (CUSTOMER): 80670 ms
Interruptions: 0
Overall Sentiment: AGENT=0.6, CUSTOMER=0.3
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/04/10/857cf69e-d815-4450-a673-bd1886dfe955_20250410T15:07_UTC.wav
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[AGENT][NEUTRAL] Thank you for calling American Public Life. This is [PII]. How may I help you?
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] Good morning, [PII]. My name is [PII]. I'm calling from Midwest Sinus Sleep and Allergy, and we have a patient coming in who has this insurance, a secondary insurance, and he's provided that. So I guess I just need to, I'm not familiar with it, need to verify eligibility and see if it covers what he's coming in for.
[AGENT][NEUTRAL] I'll be happy to verify benefits and eligibility. [PII], may I have a policy number?
[CUSTOMER][NEUTRAL] Sure, 01897874.
[AGENT][POSITIVE] Thank you. May I have a good callback number for you?
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] Thank you, may I have the patient's name and date of birth.
[CUSTOMER][NEUTRAL] [PII] again, [PII].
[AGENT][NEUTRAL] Thank you for verifying that information. Please be advised that verification of coverage does not guarantee the payment of a claim. This policy is effective. [PII] and it is active.
[CUSTOMER][NEUTRAL] Right.
[AGENT][NEUTRAL] And which benefit can I provide for you today?
[CUSTOMER][NEUTRAL] Well it looks like he has Aetna as primary so I guess it's it's, I just need to see if it covers a specialist office visit or if if there's certain things that it does or does not cover.
[AGENT][NEUTRAL] OK, so under this.
[CUSTOMER][NEUTRAL] If it covers me
[AGENT][NEUTRAL] Go ahead.
[CUSTOMER][NEUTRAL] Go ahead, I'm sorry.
[AGENT][NEUTRAL] No, you're fine, go ahead.
[CUSTOMER][NEUTRAL] Oh no, that's fine.
[AGENT][NEUTRAL] So,
[CUSTOMER][NEUTRAL] No, I just wanted because he's listed it as secondary so I just wanna make sure it covers medical.
[CUSTOMER][NEUTRAL] A medical expense that is primary would not, you know, it, it's a backup insurance. I'm, I'm just not familiar with that.
[AGENT][NEUTRAL] Yes, this plan will pick up the copays, the co-insurance and or deductibles following the primary. Under this policy, this has office treatment, but not the actual office visit benefit. So any treatment received in the doctor's office falls under the outpatient calendar year benefit amount of 3500.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEGATIVE] It just does not cover.
[CUSTOMER][NEUTRAL] So I need to base the office visit on his primary but everything OK, that's, that's perfect so it excludes office visits.
[AGENT][NEUTRAL] Yes, ma'am.
[AGENT][POSITIVE] Correct.
[CUSTOMER][NEUTRAL] OK, that's what I needed to know. And then do you guys use reference numbers, [PII]?
[AGENT][NEUTRAL] Yes, it will be my name which is [PII] Last initial is [PII] along with today's date. [PII], is there anything else I can assist you with?
[CUSTOMER][POSITIVE] Nope, that's what I needed thank you so much for your time.
[AGENT][POSITIVE] You're so welcome and thank you for calling American Public Life, [PII]. Have a great day. Bye-bye.
[CUSTOMER][NEUTRAL] You too bye.