AccountId: 011433970860
ContactId: a28c8f7f-26e5-4bc6-aa4d-d0a6c23e690c
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 271220 ms
Total Talk Time (AGENT): 149378 ms
Total Talk Time (CUSTOMER): 105507 ms
Interruptions: 2
Overall Sentiment: AGENT=1.1, CUSTOMER=1.4
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/01/17/a28c8f7f-26e5-4bc6-aa4d-d0a6c23e690c_20250117T16:26_UTC.wav
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[AGENT][POSITIVE] Good Morning. Thank you for calling APL. This is [PII]. How may I assist you?
[CUSTOMER][NEUTRAL] Hi, so, my name's [PII], that's [PII]
[CUSTOMER][NEUTRAL] [PII] as my first initial to my last name. I'm calling on a recorded line on behalf of OneSource for the provider, Dr. [PII].
[AGENT][NEUTRAL] Mhm.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] OK. And how may I assist you today, Ms. [PII]?
[CUSTOMER][NEUTRAL] I was just calling today just to see if there was any way that I could get possibly some eligibility and benefits for a patient and just to check to see if the medication would be covered.
[AGENT][POSITIVE] OK, sure, I can assist you with the eligibility and benefits. May I have a callback number just in case we get disconnected?
[CUSTOMER][NEUTRAL] Yes, [PII].
[AGENT][NEUTRAL] Thank you and may I have the patient's policy number?
[CUSTOMER][NEUTRAL] Yes, that would be 02479217.
[AGENT][NEUTRAL] What's the name and date of birth of the patient?
[CUSTOMER][NEUTRAL] [PII], [PII].
[AGENT][POSITIVE] All right. Thank you.
[AGENT][NEUTRAL] OK, so this is gonna be um an office procedure?
[CUSTOMER][NEUTRAL] Yes.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] 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. And this is one of our secondary supplemental plan to the major medical with an effective date of [PII] and it is active at the moment.
[AGENT][NEUTRAL] And with this one, let's see.
[AGENT][NEUTRAL] OK, so this one covers office procedures or treatment, but it doesn't cover the office visit. The office procedures and treatments are subject to the outpatient maximum which is $3000 per covered person per calendar year.
[CUSTOMER][NEUTRAL] OK, so you said they have an out of pocket maximum of 3000?
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] OK, have they met any of that yet?
[AGENT][NEUTRAL] Yes, normally cover.
[AGENT][NEUTRAL] It started all over again this year. I can check and see if they have used anything, which I don't think so, but I can check to make sure, yeah.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][POSITIVE] Probably not, yeah, because it's the beginning of the year you're so right.
[AGENT][NEUTRAL] Yeah, it's a little bit too early.
[AGENT][NEUTRAL] Alright, yeah. OK, so now they have not used their benefits for [PII] as today. Well, we have not received any claims as of today.
[CUSTOMER][POSITIVE] Perfect, and they have no deductible, correct?
[AGENT][NEUTRAL] Not with us because we're just the secondary. Mhm.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][POSITIVE] OK perfect perfect perfect just wanted to check and then do you happen to see um a possible pharmacy benefit manager on file?
[AGENT][NEUTRAL] Mhm.
[AGENT][NEUTRAL] This one doesn't cover any pharmaceuticals. It's just for the, um, yeah, just for the um um how you say that, I forgot the name. OK, uh for the procedure to put it in, but not for the medicine itself.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] I got you I got you so then you wouldn't you.
[AGENT][NEUTRAL] Administration there you go.
[CUSTOMER][POSITIVE] I got it hey it's Monday. It's one of those days already. I get it.
[AGENT][POSITIVE] That's nice
[AGENT][NEUTRAL] Yeah
[AGENT][POSITIVE] Thank you so much.
[AGENT][NEUTRAL] OK
[CUSTOMER][NEUTRAL] So would this mean that the medicine more than likely would not be covered as well because you guys only cover visits?
[AGENT][NEUTRAL] Correct, we only cover the administration of it.
[CUSTOMER][NEUTRAL] OK, OK.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][POSITIVE] Alrighty, well thank you so much, [PII] for all the help. I think, I think that completes all my questions. If it does not, I will return the phone call, not a big deal for me. Um, I think my final two questions would just be do we have a reference number for today? And do you, may I have the spelling of your name and the first initial to your last name actually?
[AGENT][NEUTRAL] Yeah
[AGENT][NEUTRAL] Sure, anytime.
[AGENT][NEUTRAL] Sure. Yes, the spelling of my name is [PII]. That's [PII]. Last initial is [PII], and we don't have reference numbers. You can use my name and today's date if you would like it, [PII]. Is there anything else I can help you with today?
[CUSTOMER][NEUTRAL] Nope, I think that covers it. If not, you might hear from me again soon.
[AGENT][NEUTRAL] OK
[AGENT][NEUTRAL] All right.
[AGENT][POSITIVE] Well, thank you for calling APR. You have a good day and if you need to call back, no problem. You can always call back, OK?
[CUSTOMER][POSITIVE] Thank you so much, so I hope you have a wonderful day. Take care.
[AGENT][POSITIVE] You're welcome. You too. Have a nice weekend. Bye-bye. Thank you.
[CUSTOMER][NEUTRAL] Bye.