AccountId: 011433970860
ContactId: b875c885-a407-44e2-9eab-292595e0c582
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 330640 ms
Total Talk Time (AGENT): 102372 ms
Total Talk Time (CUSTOMER): 87988 ms
Interruptions: 0
Overall Sentiment: AGENT=-0.2, CUSTOMER=0
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/06/16/b875c885-a407-44e2-9eab-292595e0c582_20250616T20:33_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] and I'm calling from Great Kids Pediatrics. Uh, I'm calling to check if we're in network with the patients plan.
[CUSTOMER][NEUTRAL] And then eligibility.
[AGENT][NEUTRAL] You have the member ID [PII]?
[CUSTOMER][NEUTRAL] Um,
[CUSTOMER][NEUTRAL] I have a policy number.
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] 02584605.
[AGENT][NEUTRAL] And do you have a good callback number?
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] OK, thank you. And what was the patient name and date of birth?
[CUSTOMER][NEUTRAL] Uh, [PII] [PII].
[AGENT][NEUTRAL] And you needed eligibility, is that right?
[CUSTOMER][NEUTRAL] Uh, I wanted to check first if we're in network with this plan.
[AGENT][NEUTRAL] Um, it doesn't utilize the network. You can go to any provider they like.
[CUSTOMER][NEUTRAL] You guys don't utilize in in network or networks?
[AGENT][NEUTRAL] No, this is a supplemental hospital indemnity plan. It's not like a major medical, just a supplemental policy.
[CUSTOMER][NEUTRAL] You said it was a supplemental major radical?
[AGENT][NEUTRAL] No, it's not a major medical plan. It's a supplemental plan.
[CUSTOMER][NEUTRAL] Oh OK.
[CUSTOMER][NEUTRAL] Um, OK.
[CUSTOMER][NEUTRAL] So how uh how does that work in regards to benefits?
[AGENT][NEUTRAL] Is this for an office visit?
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] Um, so it's not a guarantee of payment, basic outline of the policy, uh, for their policy looks like.
[AGENT][NEUTRAL] Outpatient visit uh pays a maximum of $75.
[AGENT][NEUTRAL] And it's a max of 5 visits per year.
[CUSTOMER][NEUTRAL] Uh, what about preventative immunizations?
[AGENT][NEUTRAL] Um, they have a wellness benefit that pays $75.
[AGENT][NEUTRAL] Uh, once per calendar year.
[CUSTOMER][NEUTRAL] Um, does that include the immunizations? because I think that's for like the Wellcare like physical, you know, like yearly physical.
[AGENT][NEUTRAL] Um, so it defines it as.
[AGENT][NEUTRAL] Uh, it would be a routine exam or other preventative test under supervision of physician.
[AGENT][NEUTRAL] Um, so,
[AGENT][NEGATIVE] That doesn't look like it would cover immunizations, no.
[CUSTOMER][NEUTRAL] OK, what about um labs done at the PCP's office?
[AGENT][NEUTRAL] Um, so routine or diagnostic?
[CUSTOMER][NEUTRAL] Uh, diagnostic.
[AGENT][NEUTRAL] Um, let's see, so diagnostic testing.
[AGENT][NEUTRAL] Uh, for that they have $250 per calendar year, and that is defined as
[AGENT][NEUTRAL] That would be for MRI, CAT scan, or colonoscopy.
[CUSTOMER][NEUTRAL] What about like um
[CUSTOMER][NEUTRAL] Like a
[CUSTOMER][NEUTRAL] Like a COVID test or a flu test.
[CUSTOMER][NEUTRAL] Like strep test or culture.
[AGENT][NEUTRAL] The diagnostic testing benefit specifically just covers those three items.
[CUSTOMER][NEUTRAL] And if it's not those, then it's probably not covered, is it?
[AGENT][NEUTRAL] It's not covered, correct.
[CUSTOMER][NEUTRAL] Right.
[CUSTOMER][NEUTRAL] OK, so for the PCP office visit it's $75 per visit or?
[AGENT][NEUTRAL] Yes, that's the max we'll pay. That's what we pay, correct.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] OK, did they use any of those 5 visits yet?
[AGENT][NEUTRAL] Uh, no, I don't show any use.
[CUSTOMER][NEUTRAL] Uh, even what about the Wellcare?
[AGENT][NEGATIVE] Uh, no, this patient has no history.
[CUSTOMER][NEUTRAL] OK, so they still have their one like well visit?
[AGENT][NEUTRAL] Yes.
[CUSTOMER][NEUTRAL] OK, can I get your name and a reference number?
[AGENT][NEUTRAL] Uh, my name is [PII], first initial [PII] name, [PII], and today's date would be the reference number, my name in today's date. And anything else I can help with today?
[CUSTOMER][NEUTRAL] Um, no, that's, that's about it.
[AGENT][POSITIVE] OK. Well, thanks for calling APL. Have a good day.
[CUSTOMER][NEUTRAL] You too bye