AccountId: 011433970860
ContactId: a288c303-0a86-4d9a-98bb-beec6073c02c
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 244250 ms
Total Talk Time (AGENT): 91678 ms
Total Talk Time (CUSTOMER): 90007 ms
Interruptions: 0
Overall Sentiment: AGENT=1.3, CUSTOMER=0.5
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/06/02/a288c303-0a86-4d9a-98bb-beec6073c02c_20250602T15:16_UTC.wav
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[AGENT][NEUTRAL] Thank you for calling APL. This is [PII]. How can I help you?
[CUSTOMER][NEUTRAL] Calling from a doctor's office to um check if a patient of ours is in network with um if rather if we're in network with our plan.
[AGENT][NEUTRAL] OK, I can get that policy pulled up and check that network. Um, what was your name? I'm sorry.
[CUSTOMER][NEUTRAL] Sure, [PII]
[AGENT][NEUTRAL] OK, and then, uh, [PII], can I get a good call back number from you in case we're disconnected?
[CUSTOMER][NEUTRAL] Sure, [PII].
[AGENT][NEUTRAL] Thank you. Uh, do you have that policy number?
[CUSTOMER][NEUTRAL] Yes, it is M as in Mary, E as in Edward 43 0 wait sorry that's the wrong one hold on.
[CUSTOMER][NEUTRAL] OK, so it's 024609887.
[AGENT][NEUTRAL] OK, and then, uh, what was the name and date of birth for the member please?
[CUSTOMER][NEUTRAL] [PII].
[CUSTOMER][NEUTRAL] Um, [PII] date of birth [PII].
[AGENT][NEUTRAL] Perfect, thank you for verifying that. Uh, so this policy is of course active. Uh, effective date was [PII], and this is a limited indemnity medical plan, so different than a traditional major medical, there is no network. You would just send the claim information directly to us.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Oh OK, um, but does she have coverage for like a like medical office visit, like a specialist office visit?
[AGENT][NEUTRAL] Uh, give me just a moment. Let me get that policy pulled up and see if office visits are covered. One moment, please.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] really
[CUSTOMER][NEUTRAL] [PII], I think that's, yeah, I think that's what um.
[AGENT][POSITIVE] Bear with me just a moment. I appreciate your patience.
[CUSTOMER][POSITIVE] Yeah, no problem.
[AGENT][POSITIVE] Thank you.
[CUSTOMER][NEUTRAL] [PII]
[AGENT][NEUTRAL] Alrighty, of course, I will let you know verification of coverage is not a guarantee of payment for claims. Uh, so this policy does have benefits for, um, office visits. It pays a maximum of $75 per visit.
[CUSTOMER][NEUTRAL] Oh
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] And the patient would be responsible for the remainder, not at a percentage, but just like that.
[AGENT][NEUTRAL] So we don't say what is patient responsibility that would be up to the provider um I can just simply tell you the maximum amount we would be able to pay.
[CUSTOMER][NEUTRAL] Difference.
[CUSTOMER][NEUTRAL] Oh, OK, so for a specialist office visit, the maximum paid is $75.
[AGENT][POSITIVE] Correct.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Um, and is this something that they would pay their visit up front and then get reimbursed?
[AGENT][NEUTRAL] No.
[AGENT][NEUTRAL] No, so, uh, you again you would just send that claim information to us. There's no copays or anything like that.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Alrighty, so.
[CUSTOMER][POSITIVE] OK, thank you for your help. Could I just get your name?
[AGENT][NEUTRAL] Sure, it's [PII] Was there anything else I could help you with, [PII]?
[CUSTOMER][NEUTRAL] Yeah just a reference number for the call.
[AGENT][NEUTRAL] Sure, reference number would just be my first name, last initial, and today's date so my last initial is A.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][POSITIVE] Got it thank you so much.
[AGENT][POSITIVE] Of course, thanks for calling APL have a great rest of your day.
[CUSTOMER][NEUTRAL] You too bye bye.
[AGENT][NEUTRAL] Bye bye.