AccountId: 011433970860
ContactId: c08f87dc-898a-4a4f-b3ed-063f3aa12e36
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 478679 ms
Total Talk Time (AGENT): 162701 ms
Total Talk Time (CUSTOMER): 104348 ms
Interruptions: 0
Overall Sentiment: AGENT=0.1, CUSTOMER=0.3
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/02/18/c08f87dc-898a-4a4f-b3ed-063f3aa12e36_20250218T19:53_UTC.wav
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[AGENT][NEUTRAL] Thank you for calling APL. This is [PII]. How can I help you?
[CUSTOMER][NEUTRAL] Hi, good afternoon, [PII]. I'm calling to um check eligibility and benefits for a patient.
[AGENT][NEUTRAL] OK, I'm happy to check on benefits and eligibility today. What's the patient's policy number?
[CUSTOMER][NEUTRAL] Uh, we were given a 17605.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] I'm guessing that's probably the group number.
[CUSTOMER][NEUTRAL] Lord have [PII]. We have like no part.
[AGENT][NEUTRAL] That's OK now.
[CUSTOMER][NEUTRAL] Oh gosh.
[AGENT][NEUTRAL] Let's see here. What's the patient's first and last name?
[CUSTOMER][NEUTRAL] OK. It's [PII], last name [PII]. Date of birth is [PII].
[AGENT][NEUTRAL] [PII]. OK, let's see.
[AGENT][NEUTRAL] OK, let's take a look by name and see what we can find here.
[AGENT][NEUTRAL] And her last name is [PII], is that right?
[CUSTOMER][POSITIVE] Correct, yeah.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] Alright, so it looks like patient does have an active plan. Uh, the effective date on it is [PII]. Do you need the policy number?
[CUSTOMER][NEUTRAL] Oh please.
[AGENT][NEUTRAL] The policy number is gonna be 02518148.
[AGENT][NEUTRAL] And we're the secondary insurance, so this is gonna cover deductible, co-pay, co-insurance, the primary does not.
[CUSTOMER][NEUTRAL] OK. It's not going to cover certain
[CUSTOMER][NEUTRAL] Um,
[CUSTOMER][NEUTRAL] Uh, I guess like infertility or things like that or it's just whatever is left over after her Cigna, um.
[AGENT][NEUTRAL] Yeah, so it would be billed to the primary first and then whatever is remaining, this would pick up the patients being seen for um fertility treatments.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] She wants to have infertility treatments done, so she requested that we call to check and see if she has infertility benefits through American Public Life.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] OK, let me see on here.
[AGENT][NEUTRAL] Outpatients.
[AGENT][NEUTRAL] So under the exclusions I don't see anything that would uh lend to the fact that it would not be covered um the plan will not pay for any expense or benefits that are not payable under their major medical, so it would need to be payable under that.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] Um, it would fall under just outpatient benefits.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] Um, and so,
[AGENT][NEUTRAL] See that.
[AGENT][NEUTRAL] The outpatient benefit max per covered person for the year is $2025.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] And that's um that was individual or like family?
[AGENT][NEUTRAL] Mhm
[AGENT][NEUTRAL] Yeah, so that's the individual. It looks like there is a family limit also. Um, the maximum.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] Uh, per plan for all covered persons combined is 6,075.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Does she have deductibles?
[AGENT][NEUTRAL] Uh, there's no deductible that I see on this, no.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Are there co-pays?
[AGENT][NEUTRAL] Mm.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Um, is there a plan type?
[AGENT][NEUTRAL] Um, so it's a secondary medling plan, that's the name of the plan, [PII]
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Mm, all right, I mean.
[CUSTOMER][NEUTRAL] As long as she doesn't need to get prior authorization for the secondary, I mean her for this insurance in order to proceed with what whatever we're doing.
[CUSTOMER][NEUTRAL] Guess that
[CUSTOMER][NEUTRAL] That's all I need.
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] I think I'm gonna just put it as I don't know what to say.
[CUSTOMER][NEUTRAL] I don't know if I should say it's excluded because it doesn't definitively say anything.
[CUSTOMER][NEUTRAL] Um, is there a reference number?
[AGENT][NEUTRAL] Yeah
[AGENT][NEUTRAL] Yeah, absolutely. Call reference is my name with my last initial and then today's date. My name again is [PII], which is [PII]
[AGENT][NEUTRAL] The last initial to my name is [PII].
[CUSTOMER][POSITIVE] Thank you, [PII] for your help.
[AGENT][POSITIVE] Mhm. You're welcome. Have a good day.
[CUSTOMER][NEUTRAL] You too. Bye-bye.
[AGENT][NEUTRAL] Bye bye.