AccountId: 011433970860
ContactId: b6a4e040-1681-4efa-8dbd-2b7508833fcb
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 322070 ms
Total Talk Time (AGENT): 123572 ms
Total Talk Time (CUSTOMER): 90387 ms
Interruptions: 0
Overall Sentiment: AGENT=0.2, CUSTOMER=0.8
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/02/28/b6a4e040-1681-4efa-8dbd-2b7508833fcb_20250228T19:05_UTC.wav
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[AGENT][NEUTRAL] Thank you for calling American Public Life. This is [PII]. How may I assist you?
[CUSTOMER][NEUTRAL] Hi, your [PII] is this [PII]. I'm calling from Maimo Pediatrics to check if some member have benefits for me uh for office visits.
[AGENT][NEUTRAL] May I have your name and a callback number?
[CUSTOMER][NEUTRAL] [PII]. [PII], initial last name [PII]
[AGENT][NEUTRAL] And [PII], may I please have the policy number?
[CUSTOMER][NEUTRAL] It is 12150261.
[CUSTOMER][NEUTRAL] And [PII]
[AGENT][NEUTRAL] And that's 12150261?
[CUSTOMER][NEUTRAL] And [PII]
[AGENT][NEUTRAL] OK, that's too many numbers.
[CUSTOMER][NEUTRAL] Mm, that's the number I have and the member gave it to me.
[AGENT][NEUTRAL] Do you have the image of the car?
[CUSTOMER][NEUTRAL] Oh.
[CUSTOMER][NEUTRAL] Yes, I have the group number. Maybe you can see with the group number?
[AGENT][NEUTRAL] OK, but can you look on there and look for outpatient benefit certification number and read that number off to me?
[CUSTOMER][NEUTRAL] Yeah, outpatient benefits certificate number is 02150261.
[CUSTOMER][NEUTRAL] And [PII]
[AGENT][NEUTRAL] And may I have the member's first and last name and their date of birth?
[CUSTOMER][NEUTRAL] [PII].
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] And you're calling in for eligibility and also for office visit benefits?
[CUSTOMER][NEUTRAL] Yes, for office visits.
[AGENT][NEUTRAL] And the correct policy number is showing 02.
[AGENT][NEUTRAL] 58.
[AGENT][NEUTRAL] 6029.
[CUSTOMER][NEUTRAL] Oh wow, it's less. You say 02586028.
[AGENT][NEUTRAL] 602 9
[CUSTOMER][NEUTRAL] 6029. OK.
[CUSTOMER][POSITIVE] Thank you.
[AGENT][NEUTRAL] You're welcome. And for the eligibility, it is showing that it is currently active. The effective date is [PII]. And in regards to office visits, verification of coverage does not guarantee the payment of the claim. For an office setting, the member does have up to $350. Hold on, let me make sure that's correct.
[CUSTOMER][NEUTRAL] Oh, the thing is, uh, you, you gave me the.
[CUSTOMER][NEUTRAL] Uh
[CUSTOMER][NEUTRAL] The policy for this year, but we send the claims for the day of service [PII], so that's why I give you the old number.
[AGENT][NEUTRAL] [PII].
[CUSTOMER][NEUTRAL] Yes.
[AGENT][NEUTRAL] OK, so were you needing status or were you needing benefits?
[CUSTOMER][NEUTRAL] A bene I wanna, I want to know if the member have benefits, uh, so we can send the claim if.
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] And for the date of service of [PII].
[AGENT][NEUTRAL] Verification of coverage does not guarantee the payment of the claim. This member does not have the office visit benefit rider, but they do have the office procedure writer that covers up to $350 per calendar day. That will go towards the primary insurance deductible, co-insurance, or co-pay for the procedure.
[AGENT][NEUTRAL] This policy is only for sickness and injury. It will not cover any preventative or wellness. Is there anything else that I can assist you with today [PII]?
[CUSTOMER][POSITIVE] Uh, that's all I need. Thank you so much. Can I get the reference number for this call?
[AGENT][NEUTRAL] The call reference will be my first name [PII], last initial of [PII], and today's date.
[CUSTOMER][POSITIVE] Thank you. Have a great day. Happy Friday.
[AGENT][POSITIVE] You're welcome. Same to you and thank you for calling American Public Life. Enjoy the rest of your day.
[CUSTOMER][NEUTRAL] Bye bye.