AccountId: 011433970860
ContactId: cf14b3f0-ecbf-4abd-8b78-1c5da4809188
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 214690 ms
Total Talk Time (AGENT): 107967 ms
Total Talk Time (CUSTOMER): 85207 ms
Interruptions: 2
Overall Sentiment: AGENT=1.7, CUSTOMER=1.5
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/01/31/cf14b3f0-ecbf-4abd-8b78-1c5da4809188_20250131T15:44_UTC.wav
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[AGENT][POSITIVE] Morning. Thank you for calling APL. My name is [PII]. How may I help you?
[CUSTOMER][NEUTRAL] Hi, I'm calling from a provider's office, um, and I wanted to check to see if um this patient's plan is in network or not.
[AGENT][POSITIVE] It would be my pleasure.
[CUSTOMER][POSITIVE] And if so get benefits, yeah.
[AGENT][POSITIVE] I will be happy to assist you. What is your name, please, ma'am?
[CUSTOMER][NEUTRAL] It's [PII]
[AGENT][NEUTRAL] Thank you, [PII]. And what is the callback number?
[CUSTOMER][NEUTRAL] [PII]
[AGENT][NEUTRAL] Thank you, [PII]. And what is the policy number for the patient, please, ma'am?
[CUSTOMER][NEUTRAL] It is 02555268.
[AGENT][NEUTRAL] And the patient's name and date of birth, please, ma'am?
[CUSTOMER][NEUTRAL] It's uh [PII]. Date of birth is [PII].
[AGENT][POSITIVE] All right, thank you. And I can help you with network information as well as benefits for [PII].
[AGENT][NEUTRAL] I am showing that her policy is active as of [PII].
[CUSTOMER][POSITIVE] Awesome
[AGENT][NEUTRAL] This policy participates in the multi-plan network, but network participation is not required.
[CUSTOMER][NEUTRAL] 47.
[AGENT][NEUTRAL] If you're, we pay both in and out of network benefits.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Um, are you able to look up the tax ID and see our tax ID and see if.
[CUSTOMER][NEUTRAL] Because I'm not sure if we're.
[CUSTOMER][NEUTRAL] If we're participant of the multi plan or not.
[AGENT][NEUTRAL] So that would strictly be through multiplan. There's no contractual involvement in the processing of our claim.
[CUSTOMER][POSITIVE] Got you OK.
[AGENT][NEUTRAL] So you need to check with multiplan.
[CUSTOMER][NEUTRAL] Um,
[CUSTOMER][NEUTRAL] Got you. OK, then can I just get the in-work benefits um.
[CUSTOMER][NEUTRAL] I'm looking specifically for a specialist office copay.
[AGENT][NEUTRAL] Sure, I can help you with that. So this is a limited indemnity policy.
[AGENT][NEUTRAL] The benefit amount that we pay for an office visit is $50 per day, maximum of 4 days per calendar year, and that is, again, you know, we don't process in regarding network information.
[CUSTOMER][NEUTRAL] OK, got you.
[AGENT][NEUTRAL] As of right now, [PII] has all four of her visits remaining for [PII].
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] And if you would please note all benefits given over the phone as a verification of coverage, not a guarantee of payment.
[CUSTOMER][NEUTRAL] Thank you, um, does she have an out of pocket maximum?
[AGENT][NEUTRAL] There's no deductible copay or co-insurance on this policy. It's an indemnity policy, meaning we just paid the benefit amount to the.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] Uh, medical services covered.
[CUSTOMER][NEUTRAL] Got you. OK, um, does this plan have any routine vision coverage?
[AGENT][NEGATIVE] Vision is not covered under this plan. It's for medical.
[CUSTOMER][NEUTRAL] OK
[CUSTOMER][NEUTRAL] Got you, um, is there um a referral needed at all?
[AGENT][NEUTRAL] No referral needed.
[CUSTOMER][POSITIVE] Got you.
[CUSTOMER][POSITIVE] Awesome.
[CUSTOMER][NEUTRAL] Um,
[CUSTOMER][POSITIVE] OK, that was all I was looking for then thank you so much.
[AGENT][POSITIVE] So it was a pleasure to assist you with those benefits today. Thank you for calling APL and I hope you have a wonderful day and a happy weekend.
[CUSTOMER][POSITIVE] You too thank you so much.
[AGENT][POSITIVE] Thank you, [PII]. Bye-bye.
[CUSTOMER][NEUTRAL] Bye bye.