AccountId: 011433970860
ContactId: a10e964a-fec6-460a-bece-a966d81ac2ab
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 451040 ms
Total Talk Time (AGENT): 232011 ms
Total Talk Time (CUSTOMER): 224538 ms
Interruptions: 5
Overall Sentiment: AGENT=0.6, CUSTOMER=0.3
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/06/09/a10e964a-fec6-460a-bece-a966d81ac2ab_20250609T19:24_UTC.wav
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[AGENT][NEUTRAL] Thank you for calling APL. This is [PII]. How can I help you?
[CUSTOMER][NEUTRAL] You said your name was [PII]?
[AGENT][NEUTRAL] Uh, [PII]
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK, hi [PII], my name is [PII]. I'm calling from Premier Family Physicians. Um, I had a couple questions about a patient's insurance. Um, I'm hope you can help me because me and him are kind of confused on his coverage who he's covered under.
[AGENT][NEUTRAL] Sure, um.
[AGENT][NEUTRAL] Oh I see. OK, so are we just needing to make sure he has an active policy with us?
[CUSTOMER][NEUTRAL] Yeah, and to see if it's like primary or secondary and also what the benefits are as well.
[AGENT][NEUTRAL] OK.
[AGENT][POSITIVE] Sure, I can check all of that for you. uh, [PII], can I get a good call back number from you first in case we're disconnected?
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Yeah, it's gonna be [PII].
[AGENT][NEUTRAL] OK, thank you. Do you have that policy number?
[CUSTOMER][NEUTRAL] Yes, it is 02622250.
[AGENT][NEUTRAL] OK, thank you and then what was the name and date of birth for the member please?
[CUSTOMER][NEUTRAL] Name is [PII] Date of birth is [PII].
[AGENT][NEUTRAL] Thank you for verifying that. OK, so this is his dental policy. Were we looking for medical?
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Yeah, so this is that's dental.
[AGENT][NEUTRAL] Yes, give me just a moment. Let me see if he does have a medical policy with us.
[CUSTOMER][NEUTRAL] Oh, OK.
[CUSTOMER][NEUTRAL] OK
[AGENT][NEUTRAL] OK, so he does, um, the only medical policy he has with us is a limited indemnity medical plan.
[CUSTOMER][NEUTRAL] I
[CUSTOMER][NEUTRAL] OK.
[AGENT][POSITIVE] I can give you that policy number whenever you're ready.
[CUSTOMER][NEUTRAL] Hm
[CUSTOMER][NEUTRAL] Um
[CUSTOMER][NEUTRAL] Yeah, can I get that from you?
[AGENT][NEUTRAL] Sure it is 0262.
[AGENT][NEUTRAL] 2248.
[CUSTOMER][NEUTRAL] OK, and then what are the benefits on that plan?
[AGENT][NEUTRAL] Give me just a minute let me get that policy pulled up and take a look, um, and then of course so that you are aware of this policy, um, of course it is active, um, and I don't see if he has any coverage outside of [PII]. I know this policy can be used as a primary, um, but I know a lot of people use it as supplemental or secondary so if he's got other policies I'm not sure.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK, probably his supplemental, no, you're good. I was just talking to myself it's probably his supplemental because he has, uh, we have a different insurance on file so.
[AGENT][NEUTRAL] Alrighty, bear with me just a moment.
[AGENT][NEUTRAL] Oh, go ahead. I'm sorry.
[AGENT][NEUTRAL] OK, alright, and of course I will let you know verification of coverage is not a guarantee of payment for claims, so I do have a bit of a breakdown of the benefits so um.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] He's got a hospital admission, hospital consignment, intensive care unit, rehabilitation benefit, um, accident and sickness, surgical benefits, uh, let's see, accident and sickness, office treatment, uh, including emergency room urgent care, uh, physical speech, occupational therapy, uh, diagnostic testing, uh, outpatient prescription drugs, ambulance, and then, uh, preventative elective surgical benefits.
[CUSTOMER][NEUTRAL] You're on there it's in there.
[CUSTOMER][POSITIVE] Good.
[CUSTOMER][NEUTRAL] So he doesn't have any like primary care?
[AGENT][NEUTRAL] Not under this policy, no. This is definitely going to be more, um, again, limited indemnity medical plan, um, designed to be more supplemental. Correct. More along the lines of, um, yeah, regarding accident, sickness, uh, things like that.
[CUSTOMER][NEUTRAL] So more like hospital stays and emergencies, OK, OK.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] You mentioned urgent care that means that he does have some coverage for urgent cares, OK.
[AGENT][NEUTRAL] Mhm.
[AGENT][NEUTRAL] Yes, um, he does have uh outpatient accident and sickness treatment under that. Uh, there is a benefit for urgent care facilities.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] As well as physician's office, excuse me, physician's office.
[CUSTOMER][NEUTRAL] What are, what are those? because we're, I mean tech technically it'd be a physician's office if you were to use it with us.
[AGENT][NEUTRAL] Yes.
[AGENT][NEUTRAL] OK, yeah, sure, so physician's office that uh benefit is $50 per day and that is maximum of 4 days per calendar year.
[CUSTOMER][NEUTRAL] 4 visits per year.
[AGENT][POSITIVE] Correct.
[AGENT][NEUTRAL] And a maximum of $50 per visit.
[CUSTOMER][NEUTRAL] Yeah
[CUSTOMER][NEUTRAL] Oh wow, um, how many visits has he used? Can you tell that?
[AGENT][NEUTRAL] Um, yes, I did just pull that up. He's not used any benefits so far this year.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Now, here's another question for you. So he has come in twice, not for like actual office visits, but he gets testosterone shots about every week or every 2 weeks. If I give you the CPT code, can you check if it's covered?
[AGENT][NEUTRAL] Mhm.
[AGENT][NEUTRAL] Mhm.
[AGENT][NEUTRAL] So I can't check specific CPT codes, but I can tell you that's not going to be a covered benefit under this policy.
[CUSTOMER][NEUTRAL] No
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] All right, so that's not covered, OK.
[CUSTOMER][NEUTRAL] OK, um, I don't know if they're the same, OK.
[CUSTOMER][NEUTRAL] Alright, I think let's see for physician's office $50 per day 4 visits per year.
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEGATIVE] Zero visits have been used. has injections are not covered.
[CUSTOMER][NEUTRAL] That's a limited indemnity, OK.
[CUSTOMER][NEUTRAL] OK, alrighty, my dear, can I get a call reference number from you?
[AGENT][NEUTRAL] Sure, uh, it would just be my first name, last initial, and today's date, uh, so my last initial is [PII], and did you have any other questions for me? I know it can be a bit confusing.
[CUSTOMER][NEUTRAL] No, that's it, um, I just, because he was confused too, um, because his other insurance had mentioned like kind of the same thing for visits per year and $50 per day kind of thing, um, and he just wants to, yeah, he just.
[AGENT][NEUTRAL] Sure.
[AGENT][NEGATIVE] Oh OK I know a lot of these are part of a uh multi plan and from what I've experienced um the members are definitely um it doesn't seem that they're uh communicated with properly regarding their coverages and what they've got and who it's with so that's very unfortunate but doesn't surprise me.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] So he, he does have a multi-plan, um, through 90 degree benefits. Do you know if that if y'all are part of that? OK.
[AGENT][NEUTRAL] Yes.
[AGENT][NEUTRAL] So we're not a part of that but I do you know again I am familiar with them um and from my understanding the benefits that he would have with them are going to be more along the lines of uh wellness I don't know the extent but if you'd like I can give you their phone number.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] I have their phone number. I talked to them earlier and they they did say that they primarily just cover like preventative, um.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] Right.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] So he got, he got the luck of the draw with his insurance, huh?
[AGENT][NEUTRAL] Man, I, you know, I never know how much they actually have. I always think, you know, if they've got something like this, I'm like I sure hope they've got something to kinda offset.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][POSITIVE] Right, OK, my dear, um, that is all I need from you for today. Thank you so much for your help.
[AGENT][NEUTRAL] All right.
[AGENT][POSITIVE] Of course yeah thanks for giving us a call. I hope you have a great rest of your day.
[CUSTOMER][POSITIVE] Thank you you too bye bye.
[AGENT][POSITIVE] Thanks bye bye.