AccountId: 011433970860
ContactId: c7fea5fc-c81d-4c08-b88d-5535da4dc981
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 521940 ms
Total Talk Time (AGENT): 200592 ms
Total Talk Time (CUSTOMER): 111625 ms
Interruptions: 0
Overall Sentiment: AGENT=0.2, CUSTOMER=0.4
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/01/15/c7fea5fc-c81d-4c08-b88d-5535da4dc981_20250115T22:21_UTC.wav
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[AGENT][NEUTRAL] Thank you for calling APL. This is [PII]. How may I help you?
[CUSTOMER][POSITIVE] Hi, I'm calling to get benefits on the patient.
[AGENT][POSITIVE] OK, I can help you with benefits. Can I get your name and your callback number just in case our call is disconnected?
[CUSTOMER][NEUTRAL] It's [PII] and it's uh [PII].
[AGENT][NEUTRAL] Thank you. And then what's the patient's name?
[CUSTOMER][NEUTRAL] It's uh [PII].
[AGENT][NEUTRAL] And what is [PII]'s date of birth?
[CUSTOMER][NEUTRAL] Her date of birth is [PII].
[AGENT][NEUTRAL] And her policy number, please?
[CUSTOMER][NEUTRAL] Policy number is 02514582.
[AGENT][NEUTRAL] OK, let me get the policy.
[AGENT][NEUTRAL] OK, I do show that the insured does have an active policy and her effective date is [PII].
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] And, and did you need benefits too or just the?
[CUSTOMER][NEUTRAL] Yes, I need benefits. Um, I'm needing benefits for a specialist office visit and outpatient surgery.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] OK, let me go ahead and pull in her policy and look at it.
[AGENT][POSITIVE] It's gonna be just a minute while it downloads for me so I can read it.
[CUSTOMER][NEUTRAL] OK, mhm.
[AGENT][NEUTRAL] OK, she does have an outpatient sickness writer of $75. She gets a maximum, and this is just to verify her coverage. It's not a guarantee of payment. She gets maximum visits per calendar year of of 5 of those for $75 and she has a surgical and anesthesia benefit rider.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] Her surgical schedule benefit is $2000.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] And then the anesthesia benefit is gonna be 25% of the surgical benefit amount.
[CUSTOMER][NEUTRAL] OK, is the out the $2000 that for or the physician fee or the um outpatient?
[AGENT][NEUTRAL] That's inpatient. Oh, you, she's having an outpatient. Let me check on the outpatient benefits real quick.
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] Uh huh and that'll be for the position fee only.
[AGENT][NEUTRAL] For the physician's fee, OK.
[CUSTOMER][NEUTRAL] Yes.
[AGENT][NEUTRAL] Give me just a second. I'm trying to, to find her outpatient benefits if she has any.
[CUSTOMER][POSITIVE] No problem.
[AGENT][NEGATIVE] Looking at it, it doesn't mention the physician's benefit, um, that the physician is paid. I don't see anything about the physician being paid. It just says ambulatory surgical center.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] And it says that a licensed facility whose primary it tells what that means and then surgical benefits if surgery.
[CUSTOMER][NEUTRAL] I
[AGENT][NEUTRAL] Due to injury or sickness performed by a physician.
[AGENT][NEUTRAL] Pay a surgical benefit, the surgical operation equal to the percentage up to the.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] I'm sorry.
[AGENT][NEUTRAL] Just in the schedule of.
[CUSTOMER][NEGATIVE] Hold on one moment. phone is cutting. And then I.
[AGENT][NEUTRAL] Yeah.
[AGENT][NEUTRAL] Yeah
[AGENT][NEUTRAL] say that
[CUSTOMER][NEUTRAL] I'm sorry, what was?
[AGENT][NEUTRAL] I'm in a hospital
[CUSTOMER][NEUTRAL] Uh huh.
[AGENT][NEUTRAL] It can be performed in a hospital on an inpatient or outpatient basis in an ambu surgical center or in patients.
[CUSTOMER][NEUTRAL] Mhm
[CUSTOMER][NEUTRAL] And that's uh the $2000 part?
[AGENT][NEUTRAL] Yes ma'am.
[CUSTOMER][NEUTRAL] OK, so it pays up to the 2000 then correct?
[CUSTOMER][NEUTRAL] OK, and um, and for the specialist so that you said it was $5 up to $75 is there any, did they still have the 5 is its remaining?
[AGENT][NEUTRAL] Yes ma'am.
[AGENT][NEUTRAL] Check for the balance for this year to see if she's used anything for [PII] real quick.
[CUSTOMER][NEUTRAL] Oh
[CUSTOMER][NEUTRAL] OK, OK.
[AGENT][NEUTRAL] No ma'am, she's not used anything so she still has that benefit available.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] And what network is this through?
[AGENT][NEUTRAL] Mhm.
[AGENT][NEUTRAL] Um, it's American Public Life where um.
[AGENT][NEUTRAL] Not a network we're not a major medical insurance.
[CUSTOMER][NEUTRAL] OK, so is that partner through like multi plan or PHCS?
[AGENT][NEUTRAL] Mm let me see if she is.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] Yes ma'am.
[AGENT][NEUTRAL] And
[CUSTOMER][NEUTRAL] I'm sorry?
[AGENT][NEUTRAL] Multi-plan.
[CUSTOMER][NEUTRAL] Multi plan OK and is um.
[CUSTOMER][NEUTRAL] Research needed?
[CUSTOMER][NEUTRAL] On this policy?
[AGENT][NEUTRAL] Um, I can transfer you multi places, not on our end, not for APL.
[AGENT][NEUTRAL] But if you wanted me to try multiply and see if it if it.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] Um, pre-treatments there do that.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK, yes, that's fine.
[AGENT][NEUTRAL] Would you like, oh, you would like for me to do that for you, OK, so I'll transfer you.
[AGENT][NEUTRAL] Is there anything else I can help you with um Ms. [PII]?
[CUSTOMER][NEUTRAL] I'm sorry, what was the last part you said?
[AGENT][NEUTRAL] Is there anything else I can help you with with APL before transfer you over?
[CUSTOMER][NEUTRAL] Uh, no, ma'am, but again it's through the multiply network, is that correct?
[AGENT][NEUTRAL] Yes, ma'am.
[CUSTOMER][NEUTRAL] OK, um, no, that was all I needed. Can I just get your name and a reference number, please?
[AGENT][NEUTRAL] OK
[AGENT][NEUTRAL] Yes ma'am, my name is [PII] and you can use my name to this date.
[CUSTOMER][POSITIVE] All right great thank you so much.
[AGENT][POSITIVE] Thank you, Miss [PII]. You have a great day and for calling APL.
[CUSTOMER][POSITIVE] You too. Thank you.
[AGENT][NEUTRAL] Mhm
[CUSTOMER][NEUTRAL] Mm bye bye.
[CUSTOMER][NEUTRAL] For questions about your privacy choices, please view our privacy policy on our website at [PII].