AccountId: 011433970860
ContactId: d0b68915-0145-4522-9bbb-a5a2365477cf
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 408380 ms
Total Talk Time (AGENT): 195668 ms
Total Talk Time (CUSTOMER): 131393 ms
Interruptions: 1
Overall Sentiment: AGENT=1.2, CUSTOMER=0.5
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/01/10/d0b68915-0145-4522-9bbb-a5a2365477cf_20250110T16:29_UTC.wav
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[AGENT][POSITIVE] Good morning. Thank you for calling APL. This is [PII]. How may I assist you?
[CUSTOMER][NEUTRAL] Yes, good uh good morning. My name is [PII]. I'm calling from urology specialty care. I just had to get benefits for a specialist office visit for a patient.
[AGENT][NEUTRAL] OK, sure, I can assist you with office benefits, Ms. [PII], and may I have a callback number just in case we get disconnected?
[CUSTOMER][NEUTRAL] Yes, it is [PII].
[AGENT][NEUTRAL] Thank you. And may I have the patient's policy number?
[CUSTOMER][NEUTRAL] Yes, it is 0225583.
[CUSTOMER][NEUTRAL] 4 M as in Mary, L as in Larry 8.
[AGENT][NEUTRAL] OK. May I have the name and date of birth of the patient?
[CUSTOMER][NEUTRAL] [PII], date of birth [PII].
[AGENT][POSITIVE] OK, thank you.
[AGENT][NEUTRAL] Right. And before I give you any benefit information, I need to let you know that this is not a guarantee of payment, just a verification of coverage and that's just a disclaimer. Um, with this particular policy, we do not cover office. This is only for outpatient facilities, surgical centers, diagnostic centers, um, urgent care facilities, and ER visits.
[CUSTOMER][NEUTRAL] OK, and how much does it cover?
[AGENT][NEUTRAL] OK, for any of those, we have an outpatient maximum of $1000 per covered person per calendar year. If it's an ER visit, there is a $200 deductible.
[CUSTOMER][NEUTRAL] Per year.
[CUSTOMER][NEUTRAL] We
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] And is um can you tell me how much is remaining of all uh remaining?
[AGENT][NEUTRAL] It started all over again this year. Um, I can check just to make sure, but I'm pretty sure they have not used it or we have not received any claim as of today, but let me double check, OK?
[AGENT][NEUTRAL] Yeah, no, the funds are still available. I start all over again on this year.
[CUSTOMER][POSITIVE] OK, sounds great and I do have a couple more patients if that's OK.
[AGENT][NEUTRAL] OK, sure. I just need to make a note on each one before I move forward to the next one. OK, so let me go ahead and finalize this.
[CUSTOMER][NEUTRAL] Yeah, of course.
[CUSTOMER][NEUTRAL] Is there a different reference number for each one?
[AGENT][NEUTRAL] No, no, it's my name in today's day. We don't have reference numbers, Ms. [PII].
[CUSTOMER][NEUTRAL] OK, can I get your name again?
[AGENT][NEUTRAL] Sure. My name is [PII].
[AGENT][NEUTRAL] And um see, and may I have the spelling of your name just to make sure I'm spelling it correctly.
[CUSTOMER][POSITIVE] Perfect.
[CUSTOMER][NEUTRAL] Yes, it's [PII]
[AGENT][NEUTRAL] Uh
[AGENT][NEUTRAL] OK.
[AGENT][POSITIVE] All right, I'm ready for the next one whenever you are.
[CUSTOMER][NEUTRAL] Yes, give me one second, um.
[AGENT][NEUTRAL] Yeah, sure.
[CUSTOMER][NEUTRAL] You need the member ID or the.
[AGENT][NEUTRAL] Policy number.
[CUSTOMER][NEUTRAL] Or the policy number?
[AGENT][NEUTRAL] Certificate. Mhm.
[CUSTOMER][NEUTRAL] OK, so this is policy number.
[CUSTOMER][NEUTRAL] So it's 01975793 ML 8.
[AGENT][NEUTRAL] OK. What's the name and date of birth of the patient?
[CUSTOMER][NEUTRAL] [PII] [PII].
[AGENT][POSITIVE] OK perfect thank you and it's gonna be the same information office visit benefits.
[CUSTOMER][NEUTRAL] Yes.
[AGENT][NEUTRAL] OK, and this is not guarantee of payment just for verification of coverage, and this is a secondary policy as well. All right, so with this one, we do cover the office treatments or procedures, but we do not cover the office visits. So this one does have the office treatment or office procedure writer, um, and that is subject to the outpatient maximum which is 7000 per covered person per calendar year.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] You set up to 7000 a year?
[AGENT][NEUTRAL] Yes.
[CUSTOMER][NEUTRAL] 7000.
[CUSTOMER][NEUTRAL] And all of it is remaining.
[AGENT][POSITIVE] Correct, it all over again.
[CUSTOMER][NEUTRAL] For procedures.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Wait, and I'm sorry for the other one you told me it does cover outpatient procedures, right?
[AGENT][NEUTRAL] Um, the other one covers outpatient procedures not done in the office, so the other one doesn't have office benefits at all. It's just for outpatient facilities.
[CUSTOMER][NEUTRAL] Yeah, but it's so like hospital doesn't cover anything in office?
[AGENT][NEUTRAL] Hospital and office are different. So if the place of service is um an office on the other policy on the one prior that we discussed, it doesn't cover. If it, if the place of service is a hospital, then it will be considered.
[AGENT][NEUTRAL] But if it's an office, it will not pay.
[CUSTOMER][NEUTRAL] OK, OK, OK.
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] OK, and this one does cover office procedures.
[AGENT][NEUTRAL] Correct. This one does cover the office procedure. It doesn't cover the office visit. We do not cover office visits in our policies, most of our policies.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK, and then I have one more patient.
[AGENT][NEUTRAL] Alright.
[AGENT][POSITIVE] OK, I'm ready whenever you are.
[CUSTOMER][NEUTRAL] OK
[CUSTOMER][NEUTRAL] And then the last one is.
[CUSTOMER][NEUTRAL] [PII].
[CUSTOMER][NEUTRAL] [PII].
[CUSTOMER][NEUTRAL] OK, the last one is [PII].
[CUSTOMER][NEUTRAL] [PII].
[CUSTOMER][NEUTRAL] ML 7.
[AGENT][NEUTRAL] OK. What's the name and date of birth of the patient?
[CUSTOMER][NEUTRAL] It is [PII] and [PII] [PII].
[AGENT][NEUTRAL] Thank you. OK, Ms. [PII], for this one, we don't have an active policy. This one was effective [PII], terminated [PII].
[CUSTOMER][POSITIVE] OK perfect I'll put that here in my notes.
[AGENT][NEUTRAL] Yeah.
[CUSTOMER][POSITIVE] Alright perfect thank you you you have a great day.
[AGENT][POSITIVE] You're welcome, sir. You as well, Mr. [PII]. Thank you for calling APR. Have a happy weekend.
[CUSTOMER][NEUTRAL] You too bye bye.
[AGENT][POSITIVE] Thank you. Bye.