AccountId: 011433970860
ContactId: caf65e59-7b80-46db-9ee6-dab40dca2529
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 280880 ms
Total Talk Time (AGENT): 107834 ms
Total Talk Time (CUSTOMER): 127618 ms
Interruptions: 0
Overall Sentiment: AGENT=2, CUSTOMER=0.7
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/04/01/caf65e59-7b80-46db-9ee6-dab40dca2529_20250401T16:33_UTC.wav
--------------------------------------------
[AGENT][POSITIVE] Thank you for contacting APL. My name is [PII]. How may I help you?
[CUSTOMER][NEUTRAL] Good morning. Good afternoon, [PII]. I'm calling from Doctor [PII]'s office OBGYN.
[CUSTOMER][NEUTRAL] I'm calling to see if the patient is still active under this plan and also if it's cover copay, deductible, out of pocket.
[AGENT][NEUTRAL] I can certainly look that up. With whom am I speaking, please?
[CUSTOMER][NEUTRAL] [PII]
[AGENT][NEUTRAL] OK, thank you. I'm just gonna get that going here. Hang on just a second.
[AGENT][NEUTRAL] OK. And do you have the um policy number for me, really?
[CUSTOMER][NEUTRAL] Um, let's see.
[CUSTOMER][NEUTRAL] For the outpatient benefits, I have 02478709, M as in Mary, L as in Larry, number 8.
[AGENT][NEUTRAL] Thank you and the patient's name and date of birth, please?
[CUSTOMER][NEUTRAL] Yeah, yeah.
[CUSTOMER][NEUTRAL] [PII].
[CUSTOMER][NEUTRAL] [PII].
[AGENT][POSITIVE] I appreciate that. Thank you. If I could have a callback number, please, in the event that we're disconnected?
[CUSTOMER][NEUTRAL] [PII]
[AGENT][POSITIVE] Thank you, I appreciate that. The policy went into effect.
[AGENT][NEUTRAL] On, uh, excuse me.
[AGENT][NEUTRAL] On [PII] it is active. Now, the policy only covers treatment within a hospital. Um, so, uh, there's no um treatment for a OBGYN or a physician's office. Um.
[AGENT][NEUTRAL] The uh co-pay isn't covered, um, the uh treatment isn't covered. So this is strictly for hospital use.
[CUSTOMER][NEUTRAL] OK, so hold on.
[CUSTOMER][NEUTRAL] Um, plan.
[CUSTOMER][NEUTRAL] On
[CUSTOMER][NEUTRAL] Covers
[CUSTOMER][NEUTRAL] Of
[CUSTOMER][NEUTRAL] Hospital
[CUSTOMER][NEUTRAL] Services only.
[AGENT][NEUTRAL] That's correct, yes. It, it's only gonna cover the hospital.
[CUSTOMER][NEUTRAL] Services only.
[CUSTOMER][NEUTRAL] So let's just say she delivered in the hospital, will this plan cover the, the rest?
[AGENT][NEUTRAL] Yes, if this is in a, uh, this is in the hospital for inpatient hospital services, we will pick up the deductible, co-payment or co-insurance up to $3000. Um, of course, that's just the verification of the benefits, not a guarantee of payment, but that's per occasion. Yes, it's uh inpatient hospital or there's also a per calendar day, um.
[CUSTOMER][POSITIVE] All good
[AGENT][NEUTRAL] Uh, one for, uh, yeah, outpatient as well. But it's, it would be outpatient hospital rather than, uh, a physician's office.
[CUSTOMER][NEUTRAL] OK, so it's only cover outpatient and inpatient benefits only, not office visits.
[AGENT][POSITIVE] That's correct, yeah.
[CUSTOMER][NEUTRAL] Not office.
[AGENT][NEUTRAL] Right.
[CUSTOMER][NEUTRAL] Visit.
[CUSTOMER][NEUTRAL] Or maternity.
[CUSTOMER][NEUTRAL] Benefits. Oh, OK, well, trying to tell the patient that they don't listen to me, so.
[CUSTOMER][NEUTRAL] I called the insurance because she had a copay today, she said, I have a secondary. OK.
[AGENT][NEUTRAL] Yes, it's, it, it is, it's this it's for, it's for hospital.
[CUSTOMER][POSITIVE] Yeah, we're not in the hospital, she's seeing an OBGYN and she has a balance with us and she gave us this insurance.
[AGENT][NEUTRAL] Right, yeah.
[CUSTOMER][NEUTRAL] So it's an office.
[AGENT][POSITIVE] Correct, yeah.
[CUSTOMER][NEUTRAL] Uh, so she was only, oh yeah, only if she was admitted in the hospital or if the service was done in the hospital.
[AGENT][POSITIVE] That's, that's correct.
[CUSTOMER][NEUTRAL] Then it'll be covered, but.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK, not office visit specialist only hospital. OK, um, can I have a reference number and your name, please?
[AGENT][NEUTRAL] Yes, my name is [PII]. The first letter of my last name is [PII]. We'll use that in today's date as our reference. Is there anything else at all I can help with?
[CUSTOMER][NEUTRAL] [PII], is that[PII]?
[AGENT][POSITIVE] And that's correct.
[CUSTOMER][POSITIVE] OK, thank you so much. So you said the plan cover the outpatient and in, in hospital benefits only up to $3000?
[AGENT][NEUTRAL] Uh, that's per occasion, that's correct, yes.
[CUSTOMER][POSITIVE] OK, deductible and out of pocket and co-insurance. OK, thank you so much, [PII]. Have a nice day.
[AGENT][POSITIVE] Mhm thanks for contacting AT have a good day.