AccountId: 011433970860
ContactId: c877bb55-f1dc-474e-a8ab-aae10cc218bc
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 193779 ms
Total Talk Time (AGENT): 83307 ms
Total Talk Time (CUSTOMER): 73102 ms
Interruptions: 0
Overall Sentiment: AGENT=1, CUSTOMER=0.2
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/04/16/c877bb55-f1dc-474e-a8ab-aae10cc218bc_20250416T15:35_UTC.wav
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[AGENT][NEUTRAL] Thank you for calling APR. This is [PII]. How can I help you?
[CUSTOMER][NEUTRAL] Hi, good morning. I'm calling from uh provider office. My name is [PII]. I just need to check some benefits for a patient.
[AGENT][NEUTRAL] I'm sure you see I can assist you with benefits. Um, first, could I get a good callback number just in case we're disconnected?
[CUSTOMER][NEUTRAL] Yes, it's [PII].
[CUSTOMER][NEUTRAL] [PII]
[AGENT][NEUTRAL] OK, thank you. Now I need the policy number, please.
[CUSTOMER][NEUTRAL] Yes, I have the group number or certification number.
[AGENT][NEUTRAL] Yes, the certificate number. That's the policy number.
[CUSTOMER][NEUTRAL] Which one do you need?
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] But should I use the uh should I use the one that says outpatient because we're not hospital, right?
[AGENT][POSITIVE] Yes, that's correct. Mhm.
[CUSTOMER][NEUTRAL] OK, so it's 02.
[CUSTOMER][NEUTRAL] 444
[CUSTOMER][NEUTRAL] And 5.
[CUSTOMER][NEUTRAL] 5 letter M.
[CUSTOMER][NEUTRAL] 8.
[AGENT][NEUTRAL] OK, you said it was 02444155?
[CUSTOMER][NEUTRAL] No, 7755.
[AGENT][NEUTRAL] OK, thank you. Now, please verify the patient's name and date of birth.
[CUSTOMER][NEUTRAL] This is for [PII] and it's [PII].
[AGENT][NEUTRAL] OK. Thank you and just let me advise you that verification of coverage does not guarantee payment of claims. Um, the effective date on this policy was [PII]. The policy is still active.
[AGENT][NEUTRAL] And you said this is for outpatient benefits?
[CUSTOMER][NEUTRAL] Well, we're actually a specialist office. She's just coming to have uh an ultrasound done, but she has a copay. I just need to know if you guys cover for her copays or deductibles, stuff like that.
[AGENT][NEUTRAL] OK, for um services provided in office, including specialist office, we cover up to $750 per day for the co-insurance and the deductible after the primary insurance processes the claim, but the co-pay for the office visit is not covered.
[CUSTOMER][NEUTRAL] OK, so you only cover co-insurance and deductible by not copays.
[AGENT][POSITIVE] That's correct.
[CUSTOMER][NEUTRAL] OK. Um, what about if it's for an ultrasound or procedure?
[CUSTOMER][NEUTRAL] If it's a co-pay, no, as long as it is a copay.
[AGENT][NEUTRAL] Mhm
[AGENT][NEUTRAL] Right. Since it's taking place in the office, the co-pay is not covered.
[CUSTOMER][NEUTRAL] OK, OK, perfect, thank you. I just need your reference number.
[AGENT][NEUTRAL] For the reference number, you can use my name and today's date. My name is [PII] um it's spelled [PII] My last initial is [PII] and today's date. Um, is there anything else I can assist you with?
[CUSTOMER][POSITIVE] No, thank you so much for your help.
[AGENT][POSITIVE] OK, thank you, [PII] for calling APL. You have a great rest of your day. Mm bye.
[CUSTOMER][NEUTRAL] Bye bye you too.