AccountId: 011433970860
ContactId: 97fbe1f7-9906-46f7-88ab-19a3d2b038f8
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 567630 ms
Total Talk Time (AGENT): 164731 ms
Total Talk Time (CUSTOMER): 194398 ms
Interruptions: 1
Overall Sentiment: AGENT=0.4, CUSTOMER=0.2
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/05/28/97fbe1f7-9906-46f7-88ab-19a3d2b038f8_20250528T19:12_UTC.wav
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[AGENT][NEUTRAL] Thank you for calling APL. This is [PII]. How can I help you?
[CUSTOMER][NEUTRAL] Hi, good afternoon. My name is [PII]. I'm calling from Doctor [PII]'s office.
[CUSTOMER][NEUTRAL] I am calling to get patient benefits and eligibility.
[AGENT][POSITIVE] Um, yes, ma'am. I can assist you with benefits. Um, first, could I get your name again and a good callback number?
[CUSTOMER][NEUTRAL] Yes, it's spelled [PII]
[CUSTOMER][NEUTRAL] Callback number [PII].
[AGENT][NEUTRAL] Thank you, [PII]. Now, could I get the policy number, please?
[CUSTOMER][NEUTRAL] Yes, it's where it says outpatient benefits cert number correct?
[AGENT][NEUTRAL] Yes, ma'am. That's the policy number.
[CUSTOMER][NEUTRAL] OK, so it's 104597.
[CUSTOMER][NEUTRAL] 5, then it's M as in Mike L as in Lima, and then number 5.
[AGENT][NEUTRAL] Thank you. Now, please verify the patient's name and date of birth.
[CUSTOMER][NEUTRAL] She's [PII].
[CUSTOMER][NEUTRAL] Date of birth is [PII].
[AGENT][NEUTRAL] OK, thank you. And just let me advise you that verification of coverage does not guarantee payment of claims. Um she does have a new policy number.
[CUSTOMER][NEGATIVE] It's not the one that I provided.
[AGENT][NEUTRAL] Um, no, ma'am. She has a new one as of [PII], and I can give that to you.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK, give me one quick second because now I have to go back.
[AGENT][NEUTRAL] Sure.
[CUSTOMER][NEUTRAL] Uh, hold on.
[CUSTOMER][NEUTRAL] You said it was she's effective [PII]?
[AGENT][NEUTRAL] Um, well, just let me, let me see. [PII].
[CUSTOMER][NEUTRAL] I mean 20, I mean [PII].
[AGENT][NEUTRAL] For the new policy number.
[CUSTOMER][NEUTRAL] OK, hold on.
[CUSTOMER][NEUTRAL] OK, and what is the new, so the card you provided, now that's not the correct card?
[AGENT][NEUTRAL] Well, that sounds like it's her old card, um.
[AGENT][NEUTRAL] Yeah, and I'm giving you the information for the new one.
[CUSTOMER][NEUTRAL] OK, what is the policy number?
[AGENT][NEUTRAL] Um, the new policy number is 01480363.
[CUSTOMER][NEUTRAL] OK let me repeat that you said 01480363.
[AGENT][NEUTRAL] Yes, ma'am.
[CUSTOMER][NEUTRAL] And then the group number?
[AGENT][NEUTRAL] Um, the group number is.
[AGENT][NEUTRAL] 15494.
[CUSTOMER][NEUTRAL] OK, that's the same, OK.
[AGENT][NEUTRAL] And the effective date um for this policy, [PII] and the policy is still active.
[CUSTOMER][NEUTRAL] OK, hold on.
[CUSTOMER][NEUTRAL] Give me one quick second because.
[CUSTOMER][NEUTRAL] This is um it's still the same American public.
[AGENT][NEUTRAL] Life, yes, ma'am.
[CUSTOMER][NEUTRAL] Life insurance.
[CUSTOMER][NEUTRAL] So it's ID.
[CUSTOMER][NEUTRAL] Number 104.
[CUSTOMER][NEUTRAL] 80.
[CUSTOMER][NEUTRAL] 363.
[AGENT][NEUTRAL] Yes.
[CUSTOMER][POSITIVE] Effective.
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] Um, [PII], yeah, [PII].
[CUSTOMER][NEUTRAL] OK, and then this is secondary is is uh secondary supplemental plan.
[AGENT][NEUTRAL] Yes, it is.
[CUSTOMER][NEUTRAL] And you guys follow all of Medicare Garland?
[AGENT][POSITIVE] Yes, we do.
[CUSTOMER][NEUTRAL] You come.
[CUSTOMER][NEUTRAL] And then you guys cover deductibles, core insurance.
[CUSTOMER][NEUTRAL] And uh copies, do you guys cover copays?
[AGENT][NEUTRAL] Yeah.
[AGENT][NEUTRAL] Um, yes, for coverage services. What type of service is this for? Um, where, where will it take place?
[CUSTOMER][NEUTRAL] It's for a specialist.
[CUSTOMER][NEUTRAL] Uh, the patient now here is.
[CUSTOMER][NEUTRAL] She's here today for let me see.
[AGENT][NEUTRAL] Well, is it an office visit? Is it taking place in a doctor's office?
[CUSTOMER][POSITIVE] Yes, it's a professional office setting and she's here for actually iron infusions.
[CUSTOMER][NEUTRAL] So she would be having today we would have.
[AGENT][NEUTRAL] OK, actually,
[CUSTOMER][NEUTRAL] We would be collecting $117 for her iron treatment and that's her patient responsibility coinsurance. Is that something you guys would be picking up?
[AGENT][NEUTRAL] Well, since the service is taking place in office, there's no coverage under this policy for services provided in office. I'm only showing coverage for inpatient hospital, um, outpatient hospital, urgent care facilities and services provided in diagnostic centers such as MRI's or um echocardiograms. Is she there for an MRI or echo?
[CUSTOMER][NEUTRAL] No.
[AGENT][NEUTRAL] Or any, OK. Well, yeah, there's no coverage then.
[AGENT][NEUTRAL] Under this policy because of, uh, because of the place of service, because it's taking place in office, there's no coverage.
[CUSTOMER][NEUTRAL] So,
[CUSTOMER][NEUTRAL] Mm yeah, the basic service is um 11 office.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Cover.
[CUSTOMER][NEUTRAL] American public services.
[CUSTOMER][NEUTRAL] And does this have a limit coverage?
[AGENT][NEUTRAL] A limit
[CUSTOMER][NEUTRAL] Does it, yeah, like 1000 a year, 2000 or.
[AGENT][NEUTRAL] Um, yes, for, yes, for inpatient, if she's ever admitted, um, we cover up to 4000 per calendar year.
[AGENT][NEUTRAL] And for outpatient services, services that take place in outpatient hospital facilities, urgent care facilities, or diagnostic facilities, we cover up to $500 per day.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Per day
[AGENT][NEUTRAL] Yes, ma'am, for outpatient services.
[CUSTOMER][NEUTRAL] OK OK.
[AGENT][NEUTRAL] Except for office visits.
[CUSTOMER][POSITIVE] Yeah, I'm making sharp right here.
[CUSTOMER][NEUTRAL] OK, so I have covers.
[CUSTOMER][NEUTRAL] For impatient.
[CUSTOMER][NEUTRAL] And outpatient.
[CUSTOMER][NEUTRAL] Services.
[CUSTOMER][NEUTRAL] OK, and then I think that's it.
[CUSTOMER][NEUTRAL] Hm.
[CUSTOMER][NEUTRAL] Can I get a call reference number for this information?
[AGENT][NEUTRAL] Um, yes, ma'am. For the reference number, you can use my name and today's date. My name is [PII]. Um it's spelled [PII] Last initial is [PII] and today's date. Um, is there anything else I can assist you with?
[CUSTOMER][NEUTRAL] Excuse me
[CUSTOMER][NEUTRAL] Give me one quick second, let me just.
[CUSTOMER][NEUTRAL] No take
[CUSTOMER][NEUTRAL] Today is the [PII].
[CUSTOMER][NEUTRAL] OK
[CUSTOMER][NEUTRAL] Mm
[CUSTOMER][POSITIVE] OK, that'll be it thank you.
[AGENT][POSITIVE] Yeah, thank you, [PII], for calling APL. You have a great rest of your day. Bye.
[CUSTOMER][NEUTRAL] Mm
[CUSTOMER][NEUTRAL] Bye.