AccountId: 011433970860
ContactId: 8821c3f7-298c-45d1-8843-7cd35ff81aaa
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 194679 ms
Total Talk Time (AGENT): 110646 ms
Total Talk Time (CUSTOMER): 77780 ms
Interruptions: 2
Overall Sentiment: AGENT=0.3, CUSTOMER=0
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/03/26/8821c3f7-298c-45d1-8843-7cd35ff81aaa_20250326T21:24_UTC.wav
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[AGENT][NEUTRAL] Good afternoon. Thank you for calling APL. This is [PII]. How may I help you today?
[CUSTOMER][NEUTRAL] Yes, hello, I'm calling from Doctor [PII]'s office. I need to go over a patient's gap plan, please.
[AGENT][POSITIVE] OK, I'll be glad to help you go and give me your name and the member's policy number, please.
[CUSTOMER][NEUTRAL] OK, so my name is [PII] and the policy number of the patient is 02337173ML8. Date of birth is [PII].
[AGENT][NEUTRAL] Uh, hang on just a second. Let me get it pulled up right quick.
[AGENT][NEUTRAL] So I can look at it and while I'm pulling this up, [PII], go ahead and give me a good uh return telephone call number please, ma'am.
[CUSTOMER][NEUTRAL] It's [PII].
[AGENT][NEUTRAL] All right, [PII], now my system's moved. I can see it. Go ahead with your patience and name and date of birth.
[CUSTOMER][NEUTRAL] It's [PII] [PII].
[AGENT][NEUTRAL] Alrighty, [PII]. Thank you for that information. It looks like [PII] is the insured on this medical supplemental plan to show the original effective date is [PII]. She is current and active, but I must advise that verification of coverage is not a guarantee of payment on a claim, but you did say you want some type of benefit. Is that correct?
[CUSTOMER][NEUTRAL] Yes, what I'm calling for is to see cause she has a deductible with her primary plan. Any procedures rendered in the doctor's office will be subject to her deductible. So does this gap plan cover procedures for the patient rendered in the doctor's office?
[AGENT][NEUTRAL] Mhm.
[AGENT][NEUTRAL] Alright, let me get that benefit plan pulled up. Let's see what she has.
[AGENT][NEUTRAL] All right. Sorry, my system is moving slow today.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] Let's see. Alright, there we go. OK, looks like under this medical supplemental plan, there's no um benefits for anything done in the office, only outpatient hospital and inpatient hospital.
[CUSTOMER][NEUTRAL] So she doesn't have benefits for she doesn't have um benefits for um she doesn't have a writer for office, not for the office visit for a biopsy rendered in the office when you.
[AGENT][NEGATIVE] Nothing done in the office is covered here. Nothing.
[CUSTOMER][NEUTRAL] Nothing so then her plan is only for hospital.
[AGENT][NEUTRAL] Hospital outpatient, urgent care or inpatient? Yes, ma'am.
[CUSTOMER][NEUTRAL] Well, when they do outpatient um office procedures are considered outpatient, so can you be certain that the procedure engine in the office will not be subject to the patient's deductible?
[CUSTOMER][NEGATIVE] Like that I mean that this plan will not pick up.
[AGENT][NEUTRAL] If you
[AGENT][NEUTRAL] If you file place of treatment 22, that's outpatient, that would be considered outpatient. If it's, if it's uh treatment 11, it's not gonna be covered.
[CUSTOMER][NEUTRAL] OK, so she doesn't have a treatment writer for office procedures.
[AGENT][NEUTRAL] OK. No, ma'am.
[CUSTOMER][NEUTRAL] OK, so let me have a reference number then.
[AGENT][NEUTRAL] We do not give reference numbers, [PII], but you can use my name in today's date and my name is [PII] spelled [PII] And is that all I can help you with today, [PII]?
[CUSTOMER][NEUTRAL] [PII] Oh no, that's all. Thank you.
[AGENT][POSITIVE] Yes, ma'am. OK, well, thanks for calling APL Roads. You have a great day.
[CUSTOMER][NEUTRAL] OK bye bye.
[CUSTOMER][POSITIVE] Thank you. You too, bye bye.
[AGENT][NEUTRAL] That's me, it's a fact.