AccountId: 011433970860
ContactId: 97909575-c179-4a9c-be18-ec2bf05b6a37
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 416260 ms
Total Talk Time (AGENT): 172805 ms
Total Talk Time (CUSTOMER): 155820 ms
Interruptions: 2
Overall Sentiment: AGENT=0.2, CUSTOMER=0.2
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/03/27/97909575-c179-4a9c-be18-ec2bf05b6a37_20250327T19:47_UTC.wav
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[AGENT][NEUTRAL] Thank you for calling APL. This is [PII]. How can I help you?
[CUSTOMER][NEUTRAL] I'm sorry, what was your name?
[AGENT][NEUTRAL] [PII].
[CUSTOMER][NEUTRAL] Oh hi [PII]. My name is [PII]. I'm calling from Doctor [PII]'s office. I'm trying to uh get benefits and eligibility and to see if we, you know, are in network with this group. I never heard of this insurance.
[AGENT][NEUTRAL] Right.
[AGENT][NEUTRAL] Mhm.
[AGENT][NEUTRAL] OK. Uh, do you have a good callback number, [PII]?
[CUSTOMER][NEUTRAL] Yes, [PII].
[AGENT][POSITIVE] OK, thank you.
[AGENT][NEUTRAL] OK, do you need benefits and eligibility, is that correct?
[CUSTOMER][NEUTRAL] Yes.
[AGENT][NEUTRAL] Uh, do you have a policy number for the patient?
[CUSTOMER][NEUTRAL] The only thing she said she has is a group number 25695.
[CUSTOMER][NEUTRAL] Does that sound right?
[AGENT][NEUTRAL] Do you have the patient name and date of birth?
[CUSTOMER][NEUTRAL] I do. [PII] Date of birth [PII].
[AGENT][NEUTRAL] OK, let's see.
[AGENT][NEUTRAL] I'm gonna look this up by name because that group number I can't look it up by group number so let's see.
[CUSTOMER][NEUTRAL] Yeah, that's the only thing she gave me. I said, you have a policy number, so she says no.
[AGENT][NEUTRAL] Do you have her social by chance?
[CUSTOMER][NEGATIVE] Very strange.
[CUSTOMER][NEUTRAL] Uh, actually, hold on, I think it was in here. Hold on, let me see.
[CUSTOMER][NEUTRAL] No, I don't have her address.
[AGENT][NEUTRAL] OK, no worries. Yeah, let me look it up by name. That's fine.
[AGENT][NEUTRAL] And you said [PII], right? [PII] Is that correct?
[CUSTOMER][NEUTRAL] Correct, yeah, [PII]
[AGENT][POSITIVE] OK, thank you.
[AGENT][NEUTRAL] Let's see
[AGENT][NEUTRAL] OK, let's see, yep, I've got a policy. Let's see 2.
[AGENT][NEUTRAL] OK, got it pulled up. Let me give you her policy number for filing the claim.
[CUSTOMER][NEUTRAL] Oh, so, so I don't need the group number, right?
[AGENT][NEUTRAL] No, uh-huh.
[CUSTOMER][NEUTRAL] OK, give me one second. Hold on, let's get rid of the.
[AGENT][NEUTRAL] Sure.
[CUSTOMER][NEUTRAL] OK, what is her ID number?
[AGENT][NEUTRAL] It's 256-457-0.
[CUSTOMER][NEUTRAL] That's it? OK.
[AGENT][NEUTRAL] Um, and it's not a guarantee of payment. It's basic outline of the policy. So this is a supplemental plan. Um, it works as a supplemental policy to her major medical, um, so we will need the primary explanation of benefits when you file that claim. Let me give you the effective date and then I'll tell you what her benefits are. Uh, she's active and effective [PII].
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] So, so does she have another insurance and this is just a supplement?
[AGENT][NEUTRAL] Um, let me see if I have on file what her primary might be.
[CUSTOMER][NEUTRAL] So why would she give me this one?
[AGENT][NEUTRAL] Well, it's, it's a, it's a supplemental plan that'll pick up potentially deductible co-pay and co-insurance after the primary processes for claim.
[CUSTOMER][NEUTRAL] Right, so she needs to give me the primary. I'm an OBGYN, you know what I mean?
[AGENT][POSITIVE] Sure, yeah, got it.
[CUSTOMER][NEUTRAL] Hi [PII] calling back from Doctor [PII]'s office.
[AGENT][NEUTRAL] Um, let's see. I'm trying to see if I can see what her major medical might be. Uh, looks like Florida Blue.
[CUSTOMER][NEUTRAL] Who called you? You have a follow up appointment on the twenty-ninth week, doctor.
[CUSTOMER][NEUTRAL] I'm sorry?
[AGENT][NEUTRAL] Uh, it says Florida Blue is the major medical.
[CUSTOMER][NEUTRAL] Oh, OK, so I'll call her back about that Florida blue.
[AGENT][NEUTRAL] Yeah
[CUSTOMER][NEUTRAL] No, it was [PII] that called to reschedule your.
[AGENT][NEUTRAL] And so is this for like uh outpatient outpatient services or what type of services are we?
[CUSTOMER][NEUTRAL] Yeah, yeah, she wants to come in um.
[CUSTOMER][NEUTRAL] Uh, have a hormone consultation. Maybe she can have her annual.
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Oh, right, she, because we, when you called me, you said that um [PII] called you, but it wasn't [PII], it was [PII].
[AGENT][NEUTRAL] Let me see
[AGENT][NEUTRAL] I'm pulling up her policy, you'll give me just one moment.
[CUSTOMER][NEUTRAL] Because when you
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] No, cause, um, um.
[CUSTOMER][NEUTRAL] You part was call when they called you.
[AGENT][NEUTRAL] OK, so for her benefits, let me see if she has.
[CUSTOMER][NEUTRAL] she is and.
[AGENT][NEGATIVE] It, it will cover office treatment, but it's office treatments and procedures in the office, no benefit for the actual office visit.
[CUSTOMER][NEUTRAL] I think she went back
[AGENT][NEUTRAL] Um,
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEGATIVE] She doesn't have um a wellness benefit.
[AGENT][NEUTRAL] But any type of outpatient services, it will pay up to $750 per calendar day for outpatient services and again that's gonna be after the primary insurance has processed the claim, so.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] So it's 700.
[AGENT][NEUTRAL] 750 per calendar day.
[CUSTOMER][NEUTRAL] For what?
[CUSTOMER][NEUTRAL] For calendar.
[CUSTOMER][NEUTRAL] After the primary.
[AGENT][NEUTRAL] Yes, so whatever is left over from the primary we could potentially pay up to $750 per day.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] All right, so this isn't gonna cover her coming in for her annual or her coming in for a hormone consultation. OK, got you.
[AGENT][NEUTRAL] Yeah, it's just treatments and procedures in the office, not the actual office visits, so.
[CUSTOMER][NEUTRAL] Well, uh, treatments.
[CUSTOMER][NEUTRAL] And procedures only, OK, and your name was [PII]?
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] Yes.
[CUSTOMER][NEUTRAL] And do you have a reference number, [PII]?
[AGENT][NEUTRAL] Um, it's just my first name, [PII], last initial [PII], and then today's date. And is there anything else I can help with today, [PII]?
[CUSTOMER][NEUTRAL] So
[CUSTOMER][POSITIVE] No, that's it. Thank you so much.
[AGENT][POSITIVE] All right, thank you for calling APL. Have a great afternoon.
[CUSTOMER][POSITIVE] Thank you. You too.
[AGENT][NEUTRAL] Bye.
[CUSTOMER][NEUTRAL] Bye.