AccountId: 011433970860
ContactId: 890ea8e6-4880-4051-8f30-82b62759659d
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 212119 ms
Total Talk Time (AGENT): 96374 ms
Total Talk Time (CUSTOMER): 91258 ms
Interruptions: 0
Overall Sentiment: AGENT=0.5, CUSTOMER=-1.9
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/05/30/890ea8e6-4880-4051-8f30-82b62759659d_20250530T15:50_UTC.wav
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[AGENT][POSITIVE] Good morning. Thank you for calling APL. My name is [PII]. How may I help you?
[CUSTOMER][NEUTRAL] Yes, hi [PII], I'm calling for Doctor [PII]'s office. I need to go over benefits on a patient's gap plan.
[AGENT][NEUTRAL] OK, well, I can help you with the eligibility and benefits, and may I have your name and a good contact number?
[CUSTOMER][NEUTRAL] My name is [PII] Contact number is [PII].
[AGENT][NEUTRAL] Thank you. May I have the member's policy number?
[CUSTOMER][NEUTRAL] 02249239
[AGENT][NEUTRAL] Thank you, hold on one moment.
[AGENT][NEUTRAL] And can you verify the member's first and last name and date of birth?
[CUSTOMER][NEUTRAL] Patient's name is [PII] [PII].
[AGENT][NEUTRAL] Thank you for that and all the information provided is a verification of benefits, not a guarantee of payment. I am showing the policy is active. It's been effective since [PII].
[AGENT][NEUTRAL] And what type of benefits did you want to go over today?
[CUSTOMER][NEUTRAL] The patient has a deductible with the primary plan. Any procedures rendered in the doctor's office will be subject to his deductible. Does this gap plan cover procedures in the office?
[CUSTOMER][NEUTRAL] Was it only for hospitals?
[AGENT][NEUTRAL] OK, so the patient's policy for outpatient would pay up to $500 per occurrence.
[AGENT][NEUTRAL] There is the $25 per visit.
[CUSTOMER][NEGATIVE] The procedure rendered the, the procedures rendered in the office. I don't think that this insurance covers it because it didn't cover it last year.
[AGENT][POSITIVE] I was gonna give you the benefits for in-office and let you know that procedures.
[AGENT][NEUTRAL] are under treatment in the hospital outpatient facility or in the physician's office.
[AGENT][NEUTRAL] Would you like the benefits?
[CUSTOMER][NEUTRAL] It's not covered?
[AGENT][NEUTRAL] The procedure is considered.
[CUSTOMER][NEUTRAL] I, I need to know if they cover.
[AGENT][NEUTRAL] I, I'm answering your question, ma'am. Procedures are considered treatment. They have a rider, which is an additional benefit that covers up to $25 per visit for treatment in a physician's office. So the answer to the question is yes, but up to the $25 per visit.
[CUSTOMER][NEUTRAL] Uh huh.
[CUSTOMER][NEUTRAL] So then it's they don't cover treatment in the office, they only cover $25 towards the office visit.
[AGENT][NEUTRAL] The
[CUSTOMER][NEGATIVE] The treatment is gonna cost more than $25. This, this plan, this gap plan doesn't cover on this patient's plan, any procedures in the office. He's been coming here for years. They never covered it.
[CUSTOMER][NEGATIVE] So now this is a new year. I don't think it covers it and it's never even covered $25. So I don't, so does it cover for seizures rendered in the doctor's office or is it just for hospital so I can put it down?
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] I've already answered that question, ma'am, on the policy certificate that I'm
[CUSTOMER][NEUTRAL] No, you didn't. You said it covers up to $25.
[AGENT][NEUTRAL] That's what the policy covers. If it's not a lot, I, I, I apologize, but that's.
[CUSTOMER][NEGATIVE] $25 if it's 20, if it's $25 it's for the office visit, not for the procedure. And it gives you certain and it and it probably says 4 visits only, 4 visits only up to $25.
[AGENT][NEUTRAL] It is for treatment.
[AGENT][NEUTRAL] OK, so that is the benefit on the policy. Was there anything else I could assist you with today?
[CUSTOMER][NEGATIVE] No, you didn't, you didn't give me any benefits at all, so I have to call back and speak to somebody else who can explain it much better. Thank you.
[AGENT][NEUTRAL] That's the only benefit on the policy