AccountId: 011433970860
ContactId: c973db00-85d6-4704-b94c-afbc9cbd618e
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 239339 ms
Total Talk Time (AGENT): 105771 ms
Total Talk Time (CUSTOMER): 118129 ms
Interruptions: 2
Overall Sentiment: AGENT=2, CUSTOMER=1.1
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/03/11/c973db00-85d6-4704-b94c-afbc9cbd618e_20250311T21:27_UTC.wav
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[AGENT][NEUTRAL] Contacting APL. My name is [PII]. How may I help you?
[CUSTOMER][NEUTRAL] Hi, good afternoon, [PII]. Thank you for taking my call. This is [PII]. I'm calling from a doctor's office and uh we have a patient I'd like to see. I just need to know her benefits. Uh, she has APL as a secondary insurance, so she just gave us the card and the details. I just wanted to, you know, check if.
[AGENT][POSITIVE] Uh, yes, certainly I can help with benefits.
[CUSTOMER][NEUTRAL] Uh, American public level cover.
[AGENT][POSITIVE] Absolutely, I can help with benefits. What is the policy number, please?
[CUSTOMER][POSITIVE] Wonderful.
[CUSTOMER][NEUTRAL] Uh, yes, it's 02273056. Mary Lima 8 MLA.
[AGENT][NEUTRAL] Thank you. And the and the patient's name and date of birth, please?
[CUSTOMER][NEUTRAL] Uh, patient's name is [PII]. Let me get your date of birth.
[CUSTOMER][NEUTRAL] Uh, date of birth is [PII].
[AGENT][NEUTRAL] Thank you. Is there a callback number I can have in the event that we're disconnected?
[CUSTOMER][NEUTRAL] Oh, definitely the one I'm calling from [PII].
[AGENT][NEUTRAL] Thank you. The policy went into effect on [PII]. It is active.
[AGENT][NEUTRAL] So for this policy for outpatient services, we'll pick up the deductible, co-payment or co-insurance to $500 per calendar year or up to $4000 500 dollars per calendar day or $4000 per calendar year, and that is just a verification of those benefits, not a guarantee of payment. Is there anything in particular that I could tell you about the policy? Anything specific?
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Uh, sure. So, uh, the patient will be having it in the outpatient office. Uh, and then, uh, you said it will only be up to $500 per day, right? The maximum cap?
[AGENT][POSITIVE] That is correct, yes. Uh-huh.
[CUSTOMER][NEUTRAL] OK, got it. Uh, sure. So that's all I think I need. Is there any like, uh, the patient will have deductibles from the family, but those will be covered up to $500.
[AGENT][NEUTRAL] No, no, there's, yeah, there's no deductible from this policy. So it, um.
[CUSTOMER][NEUTRAL] Oh, no deductibles, right?
[AGENT][POSITIVE] Right, that's correct.
[CUSTOMER][POSITIVE] Got it. Thank you so much for confirming that I confirm it, uh, sure. So,
[CUSTOMER][NEUTRAL] Deductibles are not covered. Coinsurance and co-pays are.
[CUSTOMER][NEUTRAL] Right.
[AGENT][NEUTRAL] Uh, the, the co-pay is not the, the office visit co-pay is not covered, but the, um, uh, co-pay or deductible or co-insurance for the treatment or procedures within the physician's office is covered.
[CUSTOMER][NEUTRAL] Yeah, got it. That's what the patient is, you know, she's having a procedure like uh I can give you the CPT code if you need me to to get this covered and
[AGENT][NEUTRAL] Oh, I, I don't need it. Um, yeah, you just need to make sure that, that you're in network with the major medical and that there is actually a deductible co-payment or co-insurance and then we're fine.
[CUSTOMER][NEUTRAL] Yes, that is actually, uh, yes, we are a network and the primary has deductibles.
[AGENT][NEUTRAL] Right.
[CUSTOMER][NEUTRAL] Got it. So deductibles will be covered.
[AGENT][NEUTRAL] That that
[AGENT][POSITIVE] Right, that's correct.
[CUSTOMER][NEUTRAL] OK, got it. They will be covered. Sure, I heard, I thought you said the deductibles will not be covered, so that's why I just like.
[AGENT][NEUTRAL] Well, the, the office visit, the office visit one, and there's no, there's no deductible for this policy, but we pick up the deductible co-pay or coinsurance from her major medical. So it's
[CUSTOMER][NEUTRAL] For major medical. Got it. So any deductible that will be carried forward over to you guys, you will be able to cover up to $500 in a day for that.
[AGENT][POSITIVE] That is correct.
[CUSTOMER][POSITIVE] Sure, [PII], thank you so much for this information. Can you give me a reference number for the call?
[AGENT][NEUTRAL] Yes, my name is [PII]. The first letter of my last name is [PII], and we're gonna use that in today's date as a reference. Is there anything else at all that I may help with?
[CUSTOMER][POSITIVE] Uh, no, that would be all. Thank you so much again for taking the call and providing the details.
[AGENT][POSITIVE] Uh, OK, thank you for contacting AP have a good day.