AccountId: 011433970860
ContactId: b38993f0-d1f1-4b16-9249-9a262c58fcc0
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 199360 ms
Total Talk Time (AGENT): 106963 ms
Total Talk Time (CUSTOMER): 70311 ms
Interruptions: 1
Overall Sentiment: AGENT=1.4, CUSTOMER=0.6
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/01/28/b38993f0-d1f1-4b16-9249-9a262c58fcc0_20250128T19:56_UTC.wav
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[AGENT][NEUTRAL] Thank you for calling APL. This is [PII]. How can I help you?
[CUSTOMER][NEUTRAL] Hi [PII], my name is [PII]. I'm calling from Animal Pediatrics to check out benefits for one member.
[AGENT][POSITIVE] Yeah, I could take benefits for you. You said your name was [PII]?
[CUSTOMER][NEUTRAL] Yes.
[AGENT][NEUTRAL] OK, uh can I get a good call back number from you first in case we're disconnected?
[CUSTOMER][NEUTRAL] Yes, [PII].
[AGENT][NEUTRAL] Yeah
[AGENT][NEUTRAL] Thank you. Do you have the policy number?
[CUSTOMER][NEUTRAL] The policy number I have is 02269879 and [PII] number.
[AGENT][NEUTRAL] OK, I'm sorry, it was the 9 before the M.
[CUSTOMER][NEUTRAL] 979 ML 8.
[AGENT][POSITIVE] Got it OK thank you one moment.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] OK. And uh what was the name and date of birth for the insured?
[CUSTOMER][NEUTRAL] And [PII] [PII] [PII].
[AGENT][NEUTRAL] OK, thank you for verifying that, [PII]. Uh, so this policy is active. Effective date was [PII], and this is a secondary medical policy, so it is designed to help with co-pay, deductible and co-insurance after major medical pays, and we we need to look at the outpatient benefits.
[CUSTOMER][NEUTRAL] I as outpatient benefit, the patient have here co-payment for the primary insurance. I wanted to see if you cover the co-payment for the doctor.
[AGENT][NEUTRAL] Yeah.
[AGENT][NEUTRAL] Was this for um an office visit Lisa?
[CUSTOMER][NEUTRAL] Office visit, yes.
[AGENT][NEUTRAL] OK, um, so they did this policy does not cover office visits. Um, however, treatment received in office could be covered. If it was simply just the visit itself though, this policy wouldn't be able to cover that.
[CUSTOMER][NEUTRAL] So you say office visit doesn't cover like a PCP wellness, no?
[AGENT][NEUTRAL] For the visit itself correct if they receive treatment in office so it could be covered.
[CUSTOMER][NEUTRAL] Oh, gotcha. OK, got it. Let me see.
[AGENT][NEUTRAL] Yes, and I'll go ahead and let you know, um, the outpatient benefit, um, and of course I will let you know verification of coverage is not a guarantee of payment for claims. Uh, their outpatient benefit is on a per calendar day basis, so it is $250 per calendar day.
[CUSTOMER][NEUTRAL] How many, how many 50?
[AGENT][NEUTRAL] I'm sorry?
[CUSTOMER][NEUTRAL] You say $50 per canary day?
[AGENT][NEUTRAL] $250 is the maximum benefit amount uh for the outpatient benefit and that is per calendar day.
[CUSTOMER][NEUTRAL] Oh.
[CUSTOMER][POSITIVE] OK. OK. Perfect. Thank you so much, [PII], because the patient is confused. No, that's it. That's all I need.
[AGENT][NEUTRAL] Yes, did you have any other questions for me?
[AGENT][POSITIVE] OK, alright, well thanks for calling APL. I hope you have a great rest of your day.
[CUSTOMER][NEUTRAL] You too. Can I get the reference number in case a member ask me for?
[AGENT][POSITIVE] Oh yeah, of course.
[AGENT][NEUTRAL] Sure, reference number would just be my first name, last initial, and today's date. Uh so my name is spelled [PII]
[CUSTOMER][POSITIVE] [PII], OK. Thank you so much. Have a great day.
[AGENT][POSITIVE] Of course, yeah, thanks for calling ATL you too bye bye.
[CUSTOMER][NEUTRAL] Bye-bye.