AccountId: 011433970860
ContactId: b81db428-eaae-4f5b-80f6-187f6b56f082
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 384299 ms
Total Talk Time (AGENT): 165639 ms
Total Talk Time (CUSTOMER): 83795 ms
Interruptions: 0
Overall Sentiment: AGENT=0.3, CUSTOMER=0.6
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/06/23/b81db428-eaae-4f5b-80f6-187f6b56f082_20250623T17:20_UTC.wav
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[AGENT][NEUTRAL] Thank you for calling APL. This is [PII]. How can I help you?
[CUSTOMER][NEUTRAL] Hi, my name is [PII] calling from Avita Care on behalf of a patient, and I was calling to confirm their benefits and in-network status.
[AGENT][NEUTRAL] OK, I can help you with benefits, [PII]. Do you have a good callback number?
[CUSTOMER][NEUTRAL] Yes, [PII].
[AGENT][NEUTRAL] OK, thank you. And what is the policy number for the member?
[CUSTOMER][NEUTRAL] That's gonna be D 43733517.
[AGENT][NEUTRAL] OK, um, that policy is with 90 degree benefits. We do some of their policies, so I can look by last name and see if we have one of their policies.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] The last name?
[CUSTOMER][NEUTRAL] Um, that's gonna be [PII]
[CUSTOMER][NEUTRAL] Mm mm
[AGENT][NEUTRAL] OK, give me one moment.
[AGENT][NEUTRAL] And what was that first name?
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] And is this for medical benefits?
[CUSTOMER][NEUTRAL] Yes.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] S
[AGENT][NEUTRAL] OK. It looks like uh we've got her, uh, or can you verify her date of birth for me?
[CUSTOMER][NEUTRAL] Um, yes, [PII].
[AGENT][POSITIVE] OK, thank you.
[AGENT][NEUTRAL] Uh, it looks like this policy is active and effective [PII].
[AGENT][NEUTRAL] Um, let's see, this is like a limited supplemental, um,
[AGENT][NEUTRAL] Policy, um, it's a hospital indemnity policy, so let me pull up those benefits. Is it gonna be for like outpatient services or doctor's office or?
[CUSTOMER][NEUTRAL] Yes, doctor's office visits.
[AGENT][NEUTRAL] I guarantee a payment basic outline of the policy.
[AGENT][NEUTRAL] Um, for their office visit benefit, uh, there's a maximum payout of $75.05 times per calendar year.
[CUSTOMER][NEUTRAL] And does that include labs or that's just the visit?
[AGENT][NEUTRAL] That's just the visit, um, diagnostic testing.
[AGENT][NEUTRAL] Uh, that's gonna pay a maximum of 250.
[AGENT][NEUTRAL] Let me see if this specifies.
[AGENT][NEUTRAL] The tests it will cover.
[CUSTOMER][NEUTRAL] And quick question that's this is for in network providers.
[AGENT][NEUTRAL] There's not a network with this because it's like a supplemental policy.
[AGENT][NEUTRAL] So it doesn't, it doesn't have a network, um.
[AGENT][NEUTRAL] Let me see.
[AGENT][NEUTRAL] Or actually, it might be multiplan. Let me double check. Hold on just a second.
[AGENT][NEUTRAL] We don't require them to use the network, they can go anywhere they like, but let me see if they do have access to multiplan.
[AGENT][NEUTRAL] Yeah, they do have access to multiplan if they'd like to use that. Um, we don't have a list of multi-plan providers, so you'd have to check at [PII] or um I can give you their number as well.
[CUSTOMER][NEUTRAL] Mhm I think that's the number because she gave me whoever I just called, she gave me your number, but she was saying that for multi plan the provider that the patient wanted to see was out of network and she couldn't locate her.
[AGENT][NEUTRAL] OK, yeah, um, they have, they can go anywhere they like, um, like I said, but they, they can use multi plan which will create a provider discount.
[CUSTOMER][NEUTRAL] OK. And then the rest will be up to the patient.
[AGENT][NEUTRAL] Um, and then
[AGENT][NEUTRAL] Um, and then for the diagnostic testing, um, it does specify on the plan, um, that it is for MRIs, CAT scans, and colonoscopies, so it won't pay for any other type of diagnostic test.
[CUSTOMER][NEUTRAL] Do you mind repeating those 3?
[AGENT][NEUTRAL] Uh, CAT scan, MRI, and colonoscopy.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] And then I had one other question because on the card, it did say that um it was for preventative services only if the patient comes in for routine follow-ups.
[CUSTOMER][NEUTRAL] Um, with specialty.
[CUSTOMER][NEUTRAL] Would that be covered or that's still under the discounted rate?
[AGENT][NEUTRAL] Um, so the outpatient.
[AGENT][NEUTRAL] Um, they do have a wellness benefit, um, that's for a wellness exam.
[AGENT][NEUTRAL] So they've got two different benefits. There's a wellness exam and test benefit which pays 75, and that would be for routine services. And then there's an outpatient sickness benefit. So if they come in for a diagnostic office visit, it pays 75 and but that's a limit of 5 per year.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK, perfect. And is there a reference number?
[AGENT][NEUTRAL] Uh, reference number is my name is [PII], first initial to last name D as in Delta, and today's date. And anything else I can help with today, [PII]?
[CUSTOMER][POSITIVE] Um, no, that was all. You were helpful.
[AGENT][POSITIVE] OK, thanks for calling APL. I hope you have a good day.
[CUSTOMER][POSITIVE] Thank you, you too.