AccountId: 011433970860
ContactId: c4db1475-5bc1-4276-ab03-0a897633a361
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 168380 ms
Total Talk Time (AGENT): 72807 ms
Total Talk Time (CUSTOMER): 59394 ms
Interruptions: 0
Overall Sentiment: AGENT=0.9, CUSTOMER=0
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/04/25/c4db1475-5bc1-4276-ab03-0a897633a361_20250425T17:39_UTC.wav
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[AGENT][NEUTRAL] Thank you for calling APL. This is [PII]. How can I help you?
[CUSTOMER][NEUTRAL] Hi [PII], I was calling um from Direct Orthopedic care. My name is [PII] and I was trying to get benefits for one of our guests.
[AGENT][POSITIVE] All right, [PII], I'm happy to check on benefits. What's your policy number?
[CUSTOMER][NEUTRAL] It will be 02506237.
[AGENT][NEUTRAL] All right. And then [PII], can I get the patient's name and date of birth?
[CUSTOMER][NEUTRAL] [PII] [PII].
[AGENT][POSITIVE] All right, thank you so much. So the patient is active. Effective date on here is [PII].
[AGENT][NEUTRAL] We are the members secondary insurance, so this will cover deductible, co-pay, co-insurance, the primary does not.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] OK, so you, you cover.
[CUSTOMER][NEUTRAL] Everything 100%?
[AGENT][NEUTRAL] It may not cover an office visit fee. What they're coming in for what again?
[CUSTOMER][NEUTRAL] Um, this is an orthopedic specialist.
[CUSTOMER][NEUTRAL] It looks like they're being seen for the right knee pain.
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Um, I did run the regular benefits for the $60 co-pay for X-ray and office visit.
[AGENT][NEUTRAL] Um, let me check.
[AGENT][NEUTRAL] OK. So let me see here. Some of these do not cover the office visit fee, but I can double check here. One moment.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Do you guys um.
[CUSTOMER][NEUTRAL] Happen to cover uh DME.
[AGENT][NEUTRAL] Mhm. Yeah, it looks like the patient plan does cover DME and it will cover the X-ray.
[CUSTOMER][NEUTRAL] Yeah
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] Um,
[CUSTOMER][NEUTRAL] I'm
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] And
[CUSTOMER][NEUTRAL] I
[CUSTOMER][NEUTRAL] So for Demi surgical and X-ray you guys cover but you don't cover office visits.
[AGENT][NEUTRAL] Yeah, it looks like it.
[AGENT][NEUTRAL] It looks like this member's plan does actually cover an office visit fee, so their benefit amount for the year of the max, it looks like for outpatient and inpatient is 3000.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] So you guys will cover 100%?
[AGENT][NEUTRAL] Right, whatever the primary doesn't cover, we will pick up.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Alright
[AGENT][NEUTRAL] Anything else?
[CUSTOMER][NEUTRAL] No, that'll be all.
[AGENT][POSITIVE] All right. Have a good day.
[CUSTOMER][NEUTRAL] You too.