AccountId: 011433970860
ContactId: bf09d9cd-047f-45ef-b8b4-70ddcc36b8f4
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 299230 ms
Total Talk Time (AGENT): 138504 ms
Total Talk Time (CUSTOMER): 92238 ms
Interruptions: 0
Overall Sentiment: AGENT=0.7, CUSTOMER=0.9
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/05/23/bf09d9cd-047f-45ef-b8b4-70ddcc36b8f4_20250523T13:29_UTC.wav
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[AGENT][NEUTRAL] Good morning. Thank you for calling APL. This is [PII]. How may I assist you? Excuse me.
[CUSTOMER][NEUTRAL] Uh, hey, hi, my name is [PII] and the last name initial is [PII]. Uh, what's her name again with last name first initial?
[AGENT][NEUTRAL] My name is [PII]. That's [PII]. That's initial [PII].
[CUSTOMER][NEUTRAL] OK, so I just called you on behalf of facility as I need to verify benefits for a member today.
[AGENT][NEUTRAL] And may I
[AGENT][POSITIVE] OK, thank you. I sure I can assist you with benefits, Mr. [PII]. And may I have a callback number just in case we get disconnected?
[CUSTOMER][NEUTRAL] Uh, yup. It's [PII].
[AGENT][NEUTRAL] OK, thank you. And may I have the patient's policy number?
[CUSTOMER][NEUTRAL] Uh yup. That is 016.
[CUSTOMER][NEUTRAL] 116.
[CUSTOMER][NEUTRAL] 10, M as in Mike, L as in Lima.
[CUSTOMER][NEUTRAL] Number 8.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] One moment.
[CUSTOMER][NEUTRAL] I
[AGENT][NEUTRAL] May I have the name and date of birth of the patient?
[CUSTOMER][NEUTRAL] Yeah, the patient's name is [PII].
[CUSTOMER][NEUTRAL] Date of birth is
[CUSTOMER][NEUTRAL] [PII].
[AGENT][POSITIVE] Thank you.
[CUSTOMER][NEUTRAL] The.
[AGENT][NEUTRAL] Mm OK. And you said you need benefits and this is gonna be an office or is it gonna be um outpatient facility?
[CUSTOMER][NEUTRAL] Uh, yeah, yeah. So benefits for MRS services and the specialist office.
[AGENT][NEUTRAL] OK, OK, before I give you any benefit information, I need to let you know that this is not a guarantee of payment, just a verification of coverage, and that's just a disclaimer.
[AGENT][NEUTRAL] And let's see one moment.
[AGENT][NEUTRAL] OK, so for this one, we cover only office procedures. We do not cover the office visit. The office procedures are subject to the outpatient maximum of 1500 per covered person per calendar year.
[CUSTOMER][NEUTRAL] 1500 years of this procedure.
[AGENT][NEUTRAL] Um, we cover 1500 for any outpatient procedures.
[CUSTOMER][NEUTRAL] OK, that's it. Any other benefits like deductible out of pocket or deductible, co-pay coinsurance, or is 100% covered?
[AGENT][NEUTRAL] Yeah.
[AGENT][NEUTRAL] Mm, no. Let me explain this again, Mr. [PII]. This is a secondary supplemental, OK, this is a secondary supplemental plan to the major medical. Uh, we help with the co-payments, co-insurance and deductibles from the major medical. On this one, we do cover office treatments. We only cover the treatment, we do not cover the office visit.
[CUSTOMER][NEUTRAL] Uh, sure.
[CUSTOMER][NEUTRAL] You
[CUSTOMER][NEUTRAL] It
[AGENT][NEUTRAL] And this is subject to the outpatient maximum. The outpatient maximum for any outpatient service is 1500 per year.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] OK, OK, I got it what you want to say. OK, so as it is supplemental plan, so no alteration required, and 100% covered, right?
[AGENT][NEUTRAL] Mm.
[AGENT][NEUTRAL] No authorization is required, we follow primary.
[CUSTOMER][NEUTRAL] You
[CUSTOMER][NEUTRAL] Yeah, thank you for that. And as you said, it is supplementary plan. So may I know the plan name?
[AGENT][NEUTRAL] This is a secondary supplemental plan to the major medical.
[CUSTOMER][NEUTRAL] Secondary supplement.
[CUSTOMER][POSITIVE] Thank you. And what's gonna be the effective date?
[AGENT][NEUTRAL] Mhm
[AGENT][POSITIVE] Alright, let me get that for you.
[AGENT][NEUTRAL] That is [PII] and it is active at the moment.
[CUSTOMER][POSITIVE] OK. So, thank you so much. Lastly, I just want to need the call reference number. So what do you wanna wait?
[AGENT][NEUTRAL] We don't have reference numbers. You can use my name in today's date if you will. You need the spelling of my name or any other information?
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] No, your name is [PII].
[AGENT][NEUTRAL] Mhm.
[AGENT][NEUTRAL] And there's not an A.
[CUSTOMER][NEUTRAL] Right.
[AGENT][NEUTRAL] No, it's just [PII] last initial [PII]
[CUSTOMER][POSITIVE] OK. So uh thank you again for the correction.
[AGENT][NEUTRAL] Yeah.
[CUSTOMER][POSITIVE] It was a pleasure talking to you and bye for now.
[AGENT][POSITIVE] Thank you. You as well. Have a good day. Thank you for calling APR. Bye-bye.