AccountId: 011433970860
ContactId: d283081a-4011-48f2-8e56-1cd66b5af967
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 201089 ms
Total Talk Time (AGENT): 68109 ms
Total Talk Time (CUSTOMER): 109043 ms
Interruptions: 0
Overall Sentiment: AGENT=1.5, CUSTOMER=0.8
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/04/15/d283081a-4011-48f2-8e56-1cd66b5af967_20250415T14:01_UTC.wav
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[AGENT][NEUTRAL] Thanks for calling APL. This is [PII]. How may I assist you?
[CUSTOMER][NEUTRAL] Hi, good morning, uh, my name is [PII]. I'm calling to confirm benefits for member, please.
[AGENT][NEUTRAL] Sure. I can assist you with that. Can I have a callback number for you and that policy number?
[CUSTOMER][NEUTRAL] Yes, the callback number is [PII].
[CUSTOMER][NEUTRAL] And the policy number?
[CUSTOMER][NEUTRAL] It is uh let me just check here.
[CUSTOMER][NEUTRAL] Policy outpatient benefit.
[CUSTOMER][NEUTRAL] It's 0233601.
[CUSTOMER][NEUTRAL] 2, M as in Mike, L as in Larry, 8.
[AGENT][NEUTRAL] Thank you. Can you verify the patient's name and date of birth?
[CUSTOMER][NEUTRAL] Yes, her name is [PII] and her date of birth is [PII].
[AGENT][NEUTRAL] And [PII], you're calling to verify benefits eligibility for what place of service?
[CUSTOMER][NEUTRAL] Um, it's gonna be done in the specialist office and this is for maternity.
[CUSTOMER][NEUTRAL] Let me check.
[AGENT][NEUTRAL] So this member's policy does not cover office visits, however, it does cover the treatment received in the office which falls under her outpatient benefits, and her outpatient benefits is $250 per calendar calendar day, and this is not a guaranteed benefits, just a disclaimer of the policy's coverage. So her policy does not cover the visit itself, however, it will cover the procedures performed in the office.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] So
[CUSTOMER][NEUTRAL] Uh huh
[CUSTOMER][NEUTRAL] Uh, she's gonna have an ultrasound, so it will cover the ultrasound, right?
[AGENT][NEUTRAL] OK, that will cover the ultrasound, yes, cause there's treatment received in the office. She has a treatment rider.
[CUSTOMER][NEUTRAL] Oh OK
[CUSTOMER][NEUTRAL] OK, you said that it will cover it's $250 per day?
[AGENT][POSITIVE] And $50. Yes, that is correct.
[CUSTOMER][NEUTRAL] OK, let me take a note really quick here about that. So got the insurance.
[CUSTOMER][NEUTRAL] Does not cover office visits.
[CUSTOMER][NEUTRAL] Only procedures.
[CUSTOMER][NEUTRAL] Ultrasound subject.
[CUSTOMER][POSITIVE] You are covered.
[CUSTOMER][NEUTRAL] And you said it's 250 per day.
[AGENT][NEUTRAL] Yes.
[CUSTOMER][NEUTRAL] OK, got it. OK, that's actually all I needed to confirm for her I think um with her main insurance.
[CUSTOMER][NEUTRAL] She is responsible for a 20% coinsurance of $153. This will be covered by the gap insurance, right?
[AGENT][NEUTRAL] This is the gap insurance that assists with deductible co-pay and co-insurance for services covered under the policy.
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][POSITIVE] OK, got it. Alright, thank you so much for that. Can I have your name one more time?
[AGENT][NEUTRAL] My name is [PII]. Today's date is a reference because we don't provide reference numbers.
[CUSTOMER][NEUTRAL] Yeah
[CUSTOMER][NEUTRAL] OK, I'm sorry, you said the reference is your name in today's date?
[AGENT][POSITIVE] Yes, that is correct.
[CUSTOMER][NEUTRAL] The
[CUSTOMER][POSITIVE] OK, [PII], thank you so much for this information. I hope you have a wonderful day, OK?
[AGENT][POSITIVE] Thanks for calling APO. You have a great one as well. Goodbye.
[CUSTOMER][POSITIVE] Thank you bye bye.