AccountId: 011433970860
ContactId: c564ea18-8c7c-4458-9b3d-7651b5e8e869
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 261309 ms
Total Talk Time (AGENT): 128476 ms
Total Talk Time (CUSTOMER): 91079 ms
Interruptions: 0
Overall Sentiment: AGENT=1.5, CUSTOMER=1.7
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/04/15/c564ea18-8c7c-4458-9b3d-7651b5e8e869_20250415T12:43_UTC.wav
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[AGENT][POSITIVE] Good morning. Thank you for calling APL. My name is [PII]. How may I help you?
[CUSTOMER][POSITIVE] Good morning thank you for calling ATL.
[CUSTOMER][NEUTRAL] Hi, yes, I'm trying to confirm benefits and eligibility for a patient.
[AGENT][POSITIVE] OK, I can help you with both the benefits and the eligibility. May I have your name and a good contact number?
[CUSTOMER][NEUTRAL] Yes, my name is [PII]. Phone number is [PII].
[AGENT][NEUTRAL] Thank you for that. And [PII], may I have the member's policy number?
[CUSTOMER][NEUTRAL] Uh, yes, we were given policy number 02582669.
[AGENT][POSITIVE] Thank you. Hold on one moment.
[AGENT][NEUTRAL] And can you verify the member's first and last name and date of birth?
[CUSTOMER][NEUTRAL] Yeah, this should be for [PII] Broker. Uh, date of birth is [PII].
[AGENT][NEUTRAL] Thank you for that and all the information provided is a verification of benefits, not a guarantee of payment, and I am showing the policy is active, it's been effective since [PII]. And what type of benefits did you want to go over today?
[CUSTOMER][NEUTRAL] Uh, for a specialist office visit, um, the patients trying to come in, we're an orthopedic office. So I guess first off, I'm trying to confirm if we're in network, if we're able to accept the plan.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] So this member has a hospital indemnity policy, um, so for that part of the policy, there is no network, but she or he also, sorry, I was looking at the policyholder, she also has um the
[AGENT][NEUTRAL] Hold on one second because my computer just flipped.
[AGENT][NEUTRAL] She also has the PPO network through multi-plan, so for that, you would have to see if there's a network, but Multiplan is a different company. So I can give you their phone number or their website to see if you all are in network. I think it asks for like the MPI or um and then it'll
[CUSTOMER][NEUTRAL] OK, well, multi plan I know we're good. So for a network of multi plan then we're fine so I'm assuming no referral required.
[AGENT][NEUTRAL] OK.
[AGENT][POSITIVE] Oh good.
[AGENT][POSITIVE] Correct.
[CUSTOMER][NEUTRAL] OK, perfect. OK. And then the second question, is there any type of co-payment or co-insurance for a specialist visit?
[AGENT][NEUTRAL] So, hold on one moment. I'm pulling up her full, the full benefits so I can see everything, but from what I see here, no, there's no um deductible or co-pay on this policy.
[AGENT][NEUTRAL] Yeah, no, there's none.
[CUSTOMER][NEUTRAL] No deductible and no co-pay.
[CUSTOMER][NEUTRAL] OK. And is there a max out of pocket at all for this plan?
[AGENT][NEUTRAL] Hold on 1 2nd.
[AGENT][POSITIVE] It's kind of taking its time here. I apologize.
[AGENT][NEUTRAL] And you said specialist office visit, right? You're welcome.
[CUSTOMER][POSITIVE] You're OK, thank you for your help.
[CUSTOMER][POSITIVE] Yes, correct.
[AGENT][NEUTRAL] OK, hold on one moment.
[AGENT][NEUTRAL] OK, so for the office visit, the um policy will pay up to $75 per visit with a max of 5 visits per calendar year.
[AGENT][NEUTRAL] Um, there, I don't know, there's also like a wellness and a diagnostic testing benefit. I can see like would she be doing any type of testing or this is more like.
[CUSTOMER][NEUTRAL] Well, it would depend on what, what the doctor um diagnoses her with. So, I mean, we wouldn't qualify for wellness being specialty, so that's fine. Uh, how many visits has she used so far this year?
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] Hold on one moment.
[AGENT][NEUTRAL] So far they have not used any of the benefits for this year, so she still has all 5.
[CUSTOMER][NEUTRAL] OK, I'm not used and then no deductible, no copay, just $75 flat reimbursement. Alright.
[CUSTOMER][NEUTRAL] OK, perfect. Can I get a call reference number?
[AGENT][NEUTRAL] Sure, so there's no call reference number, but you can use my name and today's date. First initial and my last name is [PII].
[CUSTOMER][NEUTRAL] OK, I'm sorry. Could you spell your first name for me?
[AGENT][NEUTRAL] Mhm. [PII]
[CUSTOMER][POSITIVE] [PII] OK, perfect. I appreciate your help. Thank you so much.
[AGENT][NEUTRAL] You're welcome, [PII]. Was there anything else I can help with?
[CUSTOMER][POSITIVE] And that'll do it thank you.
[AGENT][POSITIVE] Alright, thanks for calling APO bye bye.
[CUSTOMER][NEUTRAL] Bye bye.