AccountId: 011433970860
ContactId: c50d5bdb-afce-4ba8-b66d-e6801b35d8e2
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 361850 ms
Total Talk Time (AGENT): 117739 ms
Total Talk Time (CUSTOMER): 97115 ms
Interruptions: 0
Overall Sentiment: AGENT=0.4, CUSTOMER=0.5
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/05/27/c50d5bdb-afce-4ba8-b66d-e6801b35d8e2_20250527T19:06_UTC.wav
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[AGENT][NEUTRAL] Good afternoon. Thank you for calling APL. This is speaking. May I help you?
[CUSTOMER][NEUTRAL] Um, I'm sorry, I didn't missed your name.
[AGENT][NEUTRAL] It's [PII]
[CUSTOMER][NEUTRAL] [PII], hi [PII], this is [PII], Doctor [PII]'s office. I am trying to get maternity benefits on a patient.
[AGENT][NEUTRAL] Mhm.
[AGENT][NEUTRAL] OK, I can verify benefits for you. And you say your name is [PII]?
[CUSTOMER][NEUTRAL] [PII] with Doctor [PII]'s office.
[AGENT][NEUTRAL] OK, and what is that policy number, please?
[CUSTOMER][NEUTRAL] It is D 43732631.
[AGENT][NEUTRAL] It's not one of our policy numbers. Do you have the patient's name, date of birth?
[CUSTOMER][NEUTRAL] Um,
[CUSTOMER][NEUTRAL] Oh, you know what, it's not, it's [PII]. No, hang on a minute. I've got two different ID numbers. I have a medical ID and then I have a policy certification number. Which one would it be?
[AGENT][NEUTRAL] I need policy number.
[CUSTOMER][NEUTRAL] OK, 02
[CUSTOMER][NEUTRAL] 584-836
[AGENT][NEUTRAL] OK, thank you. And do you have a callback number in case the call drops?
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Can you tell me when we file the claim is that the same ID number that we need to use?
[AGENT][NEUTRAL] Uh, yes, ma'am.
[CUSTOMER][NEUTRAL] OK
[AGENT][NEUTRAL] And verify the patient's name, date of birth.
[CUSTOMER][NEUTRAL] It's [PII] and the date of birth is [PII].
[AGENT][NEUTRAL] OK, and you say you're needing maternity benefits, correct?
[CUSTOMER][NEUTRAL] Yes ma'am.
[AGENT][NEUTRAL] OK, I'm showing her effective date of [PII]. She is active on the policy. Uh, the type of policy she has with us is the limited indemnity plan.
[AGENT][NEUTRAL] And
[AGENT][NEUTRAL] As far as maternity, uh, she has benefits for the facility being confined and she has benefits for
[AGENT][NEUTRAL] Actual delivery.
[AGENT][NEUTRAL] But it pays based on whether it's vaginal or C-section, and she has benefits for office visits, but it's not um.
[AGENT][POSITIVE] Just specifically, right.
[CUSTOMER][NEUTRAL] Not global.
[CUSTOMER][NEUTRAL] OK, what is it to start from delivery? What is her delivery coverage?
[AGENT][NEUTRAL] Uh, do you know if she's having a vaginal or C-section?
[CUSTOMER][NEUTRAL] Um, let me double check to see.
[CUSTOMER][NEUTRAL] What she's got going on here.
[CUSTOMER][NEUTRAL] OK, it's gonna be vaginal unless something you know happens at the hospital.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] Let's see.
[AGENT][NEUTRAL] I see.
[AGENT][NEUTRAL] Not a guarantee of payment, just a verification of coverage. Uh, the max payable for vaginal delivery is
[AGENT][NEUTRAL] So it, but now I don't, uh, give me one second. I'm sorry.
[AGENT][NEUTRAL] Um.
[AGENT][NEUTRAL] Um, the max payable is just 100.
[CUSTOMER][NEUTRAL] So our insurance will only cover $100 towards her deduct towards her delivery.
[AGENT][NEUTRAL] Yes, ma'am.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] And then what about the office visits?
[AGENT][NEUTRAL] Uh, for office visits, she has a benefit max $75 per day, a total of 5 visits per year.
[CUSTOMER][NEUTRAL] OK, so typical pregnancy is at least 14 visits, so they're only gonna cover $75 up to 5 visits.
[AGENT][POSITIVE] Correct. Yes, ma'am.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] And that now is that considered her prenatal and postnatal?
[AGENT][NEUTRAL] As for any office visits.
[CUSTOMER][NEUTRAL] In the office is it OK.
[AGENT][NEUTRAL] Uh-huh.
[CUSTOMER][NEUTRAL] And does she have a deductible or no?
[AGENT][NEUTRAL] No, there's no deductible, co-pay or co-insurance under this plan.
[CUSTOMER][NEUTRAL] OK, and then can I get a confirmation number please?
[AGENT][NEUTRAL] Oh, you'll get confirmation numbers, but if you like, you may use my name and today's date as reference.
[CUSTOMER][NEUTRAL] So is it [PII] and then [PII]?
[AGENT][NEUTRAL] Uh-huh.
[CUSTOMER][POSITIVE] OK alright thank you so much.
[AGENT][POSITIVE] Uh, yes, ma'am. Thank you for calling APM Ms. [PII]. Have a great day.
[CUSTOMER][POSITIVE] Have a good day.