AccountId: 011433970860
ContactId: a177c3ce-25c7-4491-a49e-8364e49868e9
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 271790 ms
Total Talk Time (AGENT): 118405 ms
Total Talk Time (CUSTOMER): 128854 ms
Interruptions: 3
Overall Sentiment: AGENT=0.8, CUSTOMER=0.8
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/02/27/a177c3ce-25c7-4491-a49e-8364e49868e9_20250227T17:28_UTC.wav
--------------------------------------------
[AGENT][POSITIVE] Good morning. Thank you for calling APPL. This is [PII]. How may I assist you?
[CUSTOMER][NEUTRAL] Hi, good morning. This is [PII] calling from my provider's office, and I'm calling to verify eligibility and benefits for one of our patients, please. Also, I need to make sure that the doctor participates with this plan.
[AGENT][NEUTRAL] Mm
[AGENT][NEUTRAL] OK, and Miss [PII], may I have a callback number just in case we get disconnected?
[CUSTOMER][NEUTRAL] It's [PII].
[AGENT][NEUTRAL] Thank you. And you're calling from which facility or provider? What's the name?
[CUSTOMER][NEUTRAL] I'm calling from NYU Langone Trinity Center.
[AGENT][NEUTRAL] OK, thank you. And may I have the patient's policy number?
[CUSTOMER][NEUTRAL] The policy number is, yes, I have it right here, uh 02596755.
[AGENT][POSITIVE] Thank you. One moment, information.
[CUSTOMER][POSITIVE] You're welcome.
[AGENT][NEUTRAL] What is the name and date of birth of the patient?
[CUSTOMER][NEUTRAL] Um, [PII] [PII].
[AGENT][NEUTRAL] Thank you. And what type of service is being rendered?
[CUSTOMER][NEUTRAL] Uh, this is gonna be an office visit, uh, PCP office visit.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] Right, and before I give you any benefit information, I need to let you know that this is not a guarantee of payment, just a verification of coverage and that's just a disclaimer.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] Yeah, let's see.
[AGENT][NEUTRAL] OK, we have an effective date of [PII]. It is active at the moment and this is one of our limited hospital indemnity plan.
[AGENT][NEUTRAL] Um, with this one, we have an office visit is covered at $50 per visit, maximum of 4 visits per person per calendar year.
[CUSTOMER][NEUTRAL] I'm sorry, can you just repeat this one more time because you were breaking up? You said it's a limited hospital.
[AGENT][NEUTRAL] Limited hospital indemnity policy.
[CUSTOMER][NEUTRAL] Indemnity.
[CUSTOMER][NEUTRAL] Policy, OK, but it does cover office visits as well, right?
[AGENT][NEUTRAL] Mhm.
[AGENT][NEUTRAL] Correct. It covers office visit. The amount that it covers is $50 per visit, maximum of 4 visits per covered person per calendar year.
[CUSTOMER][NEUTRAL] Uh-huh.
[CUSTOMER][NEUTRAL] I'm sorry, you said you're breaking up again. You said maximum.
[AGENT][NEUTRAL] Of 4 visits per covered person per calendar year.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] 4 visits per calendar year and um OK, can you check if uh the patient used any of those 4 visits so far?
[AGENT][NEUTRAL] Mhm.
[AGENT][NEUTRAL] Yeah, I can check on that. One moment.
[CUSTOMER][NEUTRAL] Uh-huh.
[CUSTOMER][NEUTRAL] And those 4 visits um include um both PCP and specialists.
[AGENT][POSITIVE] Correct, yes.
[CUSTOMER][NEUTRAL] OK, so there are only 4 visits per calendar year.
[AGENT][NEUTRAL] Mhm, yes.
[AGENT][NEUTRAL] OK, and she has not used her benefits as of today.
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] Oh she has not OK perfect um and now as far as the uh participation, can you verify the providers uh participation status with this network?
[AGENT][NEUTRAL] Mhm, mhm.
[CUSTOMER][NEUTRAL] Yeah
[AGENT][NEUTRAL] Well, this one doesn't have a network. If the provider participates with a multi plan they get that additional discount but it is not required.
[CUSTOMER][NEUTRAL] Oh OK so it's like an open network plan?
[AGENT][NEUTRAL] Yes.
[AGENT][POSITIVE] Correct.
[CUSTOMER][NEUTRAL] Open network.
[CUSTOMER][NEUTRAL] OK, got it.
[CUSTOMER][POSITIVE] Mhm thank you so much for all of this information. Can I have a reference number for this call?
[AGENT][NEUTRAL] Yeah
[AGENT][NEUTRAL] We don't have reference numbers. You can use my name in today's date if you will.
[CUSTOMER][NEUTRAL] Mhm, and can I have your name please, your first name and last name initial please?
[AGENT][NEUTRAL] I
[AGENT][NEUTRAL] That's [PII] [PII].
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][POSITIVE] [PII]. All right, thank you so much for your help again and have a good day.
[AGENT][POSITIVE] You're welcome. You as well and thank you for calling APL, Miss [PII]. Byebye. You're welcome.
[CUSTOMER][POSITIVE] Mhm thank you bye bye.