AccountId: 011433970860
ContactId: c9a0f870-c0c3-4a0d-b0da-21ffbb458813
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 220270 ms
Total Talk Time (AGENT): 90431 ms
Total Talk Time (CUSTOMER): 53252 ms
Interruptions: 0
Overall Sentiment: AGENT=1, CUSTOMER=0.6
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/03/17/c9a0f870-c0c3-4a0d-b0da-21ffbb458813_20250317T19:24_UTC.wav
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[AGENT][POSITIVE] Thank you for calling APL. my name is [PII]. How can I assist you today?
[CUSTOMER][NEUTRAL] Yes, ma'am I'm trying to verify eligibility and benefits for medical services.
[AGENT][POSITIVE] I'd be happy to assist with benefits and eligibility. May I have your first name please?
[CUSTOMER][NEUTRAL] Yes [PII].
[AGENT][NEUTRAL] And [PII], if I can get a good callback number for you?
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] And what is the policy number?
[CUSTOMER][NEUTRAL] It's gonna be 1869088.
[AGENT][NEUTRAL] Patient's name and date of birth?
[CUSTOMER][NEUTRAL] [PII] [PII].
[AGENT][NEUTRAL] Thank you for that information. Please be advised the verification of coverage is not a guarantee of payment. I do show the policy is currently active. Effective date is [PII]. And are you calling for inpatient or outpatient benefits?
[CUSTOMER][NEUTRAL] Outpatient it's gonna be for ophthalmology.
[AGENT][NEUTRAL] In an office setting?
[CUSTOMER][NEUTRAL] Yes.
[AGENT][NEUTRAL] OK, I do show that will fall under the outpatient calendar year maximum of $2550. Um, that would be only for treatment and procedures. Uh, the co-pays associated with the physician's charges would not be covered.
[CUSTOMER][NEUTRAL] I'm sorry, you said it was an out of pocket amount?
[AGENT][NEUTRAL] So that's our total benefit amount that's the amount that we pay per calendar year.
[CUSTOMER][NEUTRAL] And I'm sorry, how much was that again?
[AGENT][NEUTRAL] One moment
[AGENT][NEUTRAL] $2550.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] So when it comes to procedures, what would that fall under?
[AGENT][NEUTRAL] Anything that you bill for other than the physician's charges would be covered.
[CUSTOMER][NEUTRAL] Which would be like the office visit?
[AGENT][NEUTRAL] No, no, no, no. The office visit is.
[AGENT][NEUTRAL] What you bill for that that's related to the physician's charges is normally what's attached to their co-pay. That's not covered, but any procedures or treatment at the visit is covered.
[CUSTOMER][NEUTRAL] OK, is there any deductible information?
[AGENT][NEUTRAL] No, that is the information you'll need to get from her primary insurance with her gap insurance.
[CUSTOMER][NEUTRAL] OK, and do you guys, uh, coordinate benefits of Blue Cross Blue Shield?
[CUSTOMER][NEUTRAL] Because that would be her primary coverage.
[AGENT][NEUTRAL] We don't coordinate. You would have to once um Blue Cross processes the claim and send you an EOB, then you would file with us, but we don't coordinate with Blue Cross with you.
[CUSTOMER][POSITIVE] Alrighty and I'm so sorry, what was your name again?
[AGENT][NEUTRAL] [PII] last initial [PII], was there anything else I can assist with today?
[CUSTOMER][NEUTRAL] Uh, yes, do you have a reference number?
[AGENT][NEUTRAL] It's just my name and today's date and time.
[CUSTOMER][POSITIVE] OK, thank you so much you have a good day.
[AGENT][POSITIVE] Thank you for calling AP.