AccountId: 011433970860
ContactId: 85f17e7b-f25f-4fba-a130-dae64233645f
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 172309 ms
Total Talk Time (AGENT): 92310 ms
Total Talk Time (CUSTOMER): 65187 ms
Interruptions: 0
Overall Sentiment: AGENT=0.7, CUSTOMER=0.4
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/02/21/85f17e7b-f25f-4fba-a130-dae64233645f_20250221T19:44_UTC.wav
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[AGENT][NEUTRAL] Thank you for calling APL. This is [PII]. How can I help you?
[CUSTOMER][NEUTRAL] Oh yes [PII], my name is [PII]. I'm calling from the provider's office. I'm trying to get benefit, uh, details for uh patients plan.
[AGENT][POSITIVE] Sure, I can check those benefits for you. uh, [PII], can I get a good call back number from you first in case we're disconnected?
[CUSTOMER][NEUTRAL] Uh yeah, [PII].
[CUSTOMER][NEUTRAL] [PII].
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] Thank you and then do you have the policy number?
[CUSTOMER][NEUTRAL] Uh yes, it's 02487944.
[AGENT][NEUTRAL] OK thank you one moment.
[AGENT][NEUTRAL] Uh, what was the name and date of birth for the insured?
[CUSTOMER][NEUTRAL] [PII] [PII].
[AGENT][NEUTRAL] Perfect, thank you for verifying that, [PII]. Uh, so this policy is active. Effective date was [PII], and this is a secondary medical policy, so it is designed to help with co-pay, deductible and co-insurance after.
[AGENT][NEUTRAL] Major medical pays and we really need to look at the outpatient benefits.
[CUSTOMER][NEUTRAL] Um, so, patient is coming in for a specialist office visit. So would you guys cover the co-pay or the deductible for the primary? Is it like a gap plan?
[AGENT][NEUTRAL] Sure, let me take a look. Kind of as it's secondary medical it is dependent on um major medical so if they don't pay this policy can't um but it is considered more supplemental, so give me just a moment, let me see if that would be covered um of course I will let you know verification of coverage is not a guarantee of payment for claims. So under this policy, office visits are not covered, however, treatment received in office could be.
[AGENT][NEUTRAL] And that would go under their outpatient benefit which is $5000 max per calendar year.
[CUSTOMER][NEUTRAL] OK, so they would be responsible for any co-pay or co-insurance for their from their primary, right?
[AGENT][NEUTRAL] If it is simply the visit itself, um, then yeah, this policy would not be able to help with that, but if they received treatment in office then it could be.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK. All right. And then, um, do you have a call reference number?
[AGENT][NEUTRAL] It would just be my first name, last initial, and today's date. So my name is spelled [PII] And was there anything else I could help you with, [PII]?
[CUSTOMER][NEUTRAL] [PII]
[AGENT][NEUTRAL] Right.
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] OK. Um, no, thank you.
[AGENT][POSITIVE] Of course, thanks for calling APL. I hope you have a great rest of your day.
[CUSTOMER][POSITIVE] Thanks.