AccountId: 011433970860
ContactId: 96323189-0f19-49ec-827a-579b3bc0a5e2
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 233339 ms
Total Talk Time (AGENT): 96283 ms
Total Talk Time (CUSTOMER): 98696 ms
Interruptions: 0
Overall Sentiment: AGENT=1, CUSTOMER=0
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/02/06/96323189-0f19-49ec-827a-579b3bc0a5e2_20250206T19:09_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] Um, yes, hi [PII]. I'm calling from Doctor [PII]'s office. I need to go over benefits on a patient. However, I don't have the correct, um, policy number. Looks like when they obtained the information over the phone, they, they, he gave like 5 numbers. Doesn't make sense.
[AGENT][NEUTRAL] OK. Do you have the social security number or I can do a name search?
[CUSTOMER][NEUTRAL] A name search the patients new, um.
[CUSTOMER][NEUTRAL] First name is [PII]
[CUSTOMER][NEUTRAL] Surname is [PII]
[CUSTOMER][NEUTRAL] The date of birth is [PII].
[AGENT][NEUTRAL] And may I have your name and a good callback number?
[CUSTOMER][NEUTRAL] Uh, my name is [PII]. Callback number is [PII].
[AGENT][POSITIVE] Thank you one moment.
[CUSTOMER][NEUTRAL] Right
[AGENT][NEUTRAL] And is he the policyholder and it's not pulling up under that name.
[CUSTOMER][NEUTRAL] Let me see something hold on.
[CUSTOMER][NEUTRAL] Let me look at the primary plan hold on.
[CUSTOMER][NEUTRAL] Yeah, the yeah, [PII].
[AGENT][NEUTRAL] That's
[CUSTOMER][NEUTRAL] So you don't, you can't find her?
[AGENT][NEUTRAL] [PII]
[CUSTOMER][NEUTRAL] Yes, unless when they scheduled the appointment for the patient, they wrote down, they put down the wrong um gap plan. That's the only thing I can think of.
[AGENT][NEUTRAL] Let's see.
[CUSTOMER][NEUTRAL] And that's why you don't find the patient.
[CUSTOMER][NEUTRAL] They put her policy number uh with the with the payer ID.
[AGENT][NEUTRAL] Oh, OK.
[CUSTOMER][NEUTRAL] And they put American, maybe.
[AGENT][NEUTRAL] Hold on, I got something.
[CUSTOMER][NEGATIVE] Yeah, no, it's completely wrong.
[AGENT][NEUTRAL] Let's see.
[AGENT][NEUTRAL] I got something in here let's see.
[AGENT][NEUTRAL] 130 1968.
[AGENT][NEUTRAL] OK, so I did locate it in our system. Thank you for verifying that information. Please be advised that verification of coverage does not guarantee the payment of a claim. So I have her as 02.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] 337147
[AGENT][POSITIVE] And it looks like this plan is effective [PII] and it is active.
[AGENT][NEUTRAL] And which benefits can I provide for you?
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] So she has a deductible with her primary plan. Any procedures that are rendered in the doctor's office will be subject to her deductible. So does this gap plan cover procedures that are rendered in the office?
[AGENT][NEUTRAL] No, they do not. She does not have office visits, nor does she have the office treatment benefit.
[CUSTOMER][NEUTRAL] OK, so she only has treatment for hospitals?
[AGENT][NEUTRAL] Yes, and inpatient inpatient and outpatient.
[CUSTOMER][NEUTRAL] Right, but when they sometimes when they when they do outpatient they also cover the procedures rendered in the office.
[AGENT][NEGATIVE] This plan does not have that benefit. She does have emergency room urgent care.
[CUSTOMER][NEUTRAL] OK
[CUSTOMER][NEUTRAL] OK
[AGENT][NEUTRAL] But no office.
[CUSTOMER][NEUTRAL] OK, all right.
[CUSTOMER][NEUTRAL] Right, but for procedure, not for office visits, she has no coverage for procedures. OK, let me have a reference number, please. Thank you.
[AGENT][POSITIVE] Correct.
[AGENT][POSITIVE] Correct.
[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][NEUTRAL] OK.
[CUSTOMER][POSITIVE] No, that will be all thank you.
[AGENT][POSITIVE] You're welcome and thank you for calling American Public Life. Have a great day, [PII]. Bye-bye.
[CUSTOMER][NEUTRAL] You too bye bye.