AccountId: 011433970860
ContactId: bcb5aa84-c6b7-4b3e-87a7-9101cea1879d
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 360000 ms
Total Talk Time (AGENT): 139666 ms
Total Talk Time (CUSTOMER): 103371 ms
Interruptions: 0
Overall Sentiment: AGENT=0.8, CUSTOMER=0.6
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/06/19/bcb5aa84-c6b7-4b3e-87a7-9101cea1879d_20250619T21:01_UTC.wav
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[AGENT][NEUTRAL] Thank you for calling APL. This is [PII]. How can I help you?
[CUSTOMER][NEUTRAL] Hello, this is [PII]. Last name initial [PII]. How are you doing today?
[AGENT][POSITIVE] I'm doing well [PII] how are you?
[CUSTOMER][POSITIVE] I'm doing good also, thank you.
[AGENT][NEUTRAL] What can we help you with today?
[CUSTOMER][NEUTRAL] Um, I was trying to get some information on some benefits for a patient.
[AGENT][POSITIVE] OK, I could check some benefits for you.
[AGENT][NEUTRAL] Uh, [PII], can I get a good, uh, call back number from you first in case we're disconnected?
[CUSTOMER][NEUTRAL] That's gonna be [PII].
[AGENT][NEUTRAL] OK, thank you. And then do you have that policy number?
[CUSTOMER][NEUTRAL] Yeah, policy number is 026087997.
[AGENT][NEUTRAL] OK, and then what was the name and date of birth for the member please?
[CUSTOMER][NEUTRAL] Member's name is [PII]. Date of birth is [PII].
[AGENT][NEUTRAL] Thank you for verifying that. 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're really need to look at inpatient or outpatient benefits for this number.
[CUSTOMER][POSITIVE] Um, I believe it's impatient.
[AGENT][NEUTRAL] OK, and of course I will let you know verification of coverage is not a guarantee of payment for claims. That inpatient benefit is $7000 max per calendar year. If you'll give me one moment, I'll see if any of that has been used.
[AGENT][NEUTRAL] OK, so she's not used any of her benefits so far this year?
[CUSTOMER][NEUTRAL] OK, got it. And what about for outpatient?
[AGENT][NEUTRAL] Uh, one moment, let me get that.
[AGENT][NEUTRAL] Outpatient benefit is also $7000 per calendar year.
[CUSTOMER][NEUTRAL] OK. So you guys don't have like a specific co-pay or co-insurance, right? It's just a, uh, arranged amount?
[AGENT][NEUTRAL] Correct, and this is all their benefit amount. This policy doesn't have any, uh, deductibles or anything like that.
[CUSTOMER][NEUTRAL] OK, so.
[CUSTOMER][NEUTRAL] Give me 1 2nd, see how I put this out.
[AGENT][NEUTRAL] Uh-huh.
[CUSTOMER][NEUTRAL] Um,
[CUSTOMER][NEUTRAL] So you said they have $7000 worth of benefits, right?
[AGENT][NEUTRAL] Uh, 7000 for inpatient and then 7000 for outpatient.
[CUSTOMER][NEUTRAL] OK, got it. And there's no co-pays, no co-insurance, no nothing.
[AGENT][NEUTRAL] Right, it just goes towards uh co-pay, deductible and co-insurance after their major medical pays up to that amount.
[CUSTOMER][NEUTRAL] And
[CUSTOMER][NEUTRAL] OK, got it. And would referrals be required?
[AGENT][NEUTRAL] No, uh, referrals, authorization, nothing like that is required.
[CUSTOMER][NEUTRAL] Got it.
[AGENT][NEUTRAL] Essentially, as long as their major medical is willing to pay this policy can.
[CUSTOMER][NEUTRAL] Uh,
[CUSTOMER][NEUTRAL] Got it and do you guys have a group number?
[AGENT][NEUTRAL] Uh, one moment, let me get that.
[AGENT][NEUTRAL] That is 26853.
[CUSTOMER][NEUTRAL] 26853 and would this plan fall under an HMO EPO PPO plan?
[AGENT][NEUTRAL] I'm sorry, what was that?
[CUSTOMER][NEUTRAL] Uh, would this plan fall under an HMO EPO PPO plan?
[AGENT][NEUTRAL] No, it's just supplemental.
[CUSTOMER][NEUTRAL] To implement. OK, got it. And there's no PCP on file, right?
[AGENT][POSITIVE] Correct.
[CUSTOMER][NEUTRAL] OK, can I get a claims address?
[AGENT][NEUTRAL] Yes, that is [PII].
[AGENT][NEUTRAL] [PII].
[AGENT][NEUTRAL] And that is in [PII].
[AGENT][NEUTRAL] Zip code is [PII].
[AGENT][NEUTRAL] And I've also got a uh fax number and a pair ID if you'd like.
[CUSTOMER][NEUTRAL] Uh, no, that's OK. I just needed the claims address.
[AGENT][NEUTRAL] Sure. Was there anything else I can help you with?
[CUSTOMER][NEUTRAL] And then let me check. No, that would be it. All I need is a reference number for the call.
[AGENT][NEUTRAL] OK, that would just be my first name, last initial, and today's date. Uh so my name is spelled [PII] Last initial is A.
[CUSTOMER][POSITIVE] Then, OK. Thank you very much, [PII], um.
[CUSTOMER][NEUTRAL] OK, uh, sorry, I do have one more question about the
[AGENT][NEUTRAL] Sure.
[CUSTOMER][NEUTRAL] The benefits. Uh, would that apply to any benefit or, cause I'm looking at records here and it looks like you guys don't cover office visits with a specialist, but for allergy services, there is coverage.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] Right, yes, so for this policy office visits are not covered. However, treatment is covered, the visits are not going to be.
[CUSTOMER][NEUTRAL] OK. So no office visits are covered and then for the allergy services, there is coverage.
[CUSTOMER][NEUTRAL] OK, then yeah, I'm all set.
[AGENT][POSITIVE] Alright well thanks for giving us a call. I hope you have a great rest of your day.
[CUSTOMER][POSITIVE] You too have a good one.
[AGENT][POSITIVE] Thank you. Bye-bye.