AccountId: 011433970860
ContactId: d384b20f-c5e0-43fe-b573-c1c67a849d8a
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 344589 ms
Total Talk Time (AGENT): 166104 ms
Total Talk Time (CUSTOMER): 85999 ms
Interruptions: 0
Overall Sentiment: AGENT=0.9, CUSTOMER=0.2
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/01/06/d384b20f-c5e0-43fe-b573-c1c67a849d8a_20250106T15:58_UTC.wav
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[AGENT][POSITIVE] Good morning. Thank you for calling APL. My name is [PII]. How may I help you?
[CUSTOMER][NEUTRAL] Um, yes, hi [PII], I'm calling from Doctor [PII]'s office, and I need to go over benefits on a patient's gap plan.
[AGENT][POSITIVE] OK, well, I'll be more than happy to help you with the benefits. And may I have your name and a good contact number in case we're disconnected?
[CUSTOMER][NEUTRAL] Um, it's [PII], and that phone number is [PII].
[AGENT][NEUTRAL] Thank you. And [PII], may I have the member's policy number?
[CUSTOMER][NEUTRAL] It is 01780658ML8.
[AGENT][NEUTRAL] Thank you, hold on one moment.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] And can you verify the member's first and last name and date of birth?
[CUSTOMER][NEUTRAL] [PII] [PII].
[AGENT][NEUTRAL] Thank you for that. And all the information provided is a verification of benefits, not a guarantee of payment. So I am showing the policy is active. It's been effective since [PII]. And what type of benefits did you want to go over today?
[CUSTOMER][NEUTRAL] Well, so the patient has a deductible with the primary plan, so I need to know if this gap plan will cover um any procedures rendered in the office.
[AGENT][NEUTRAL] The office, hold on one moment.
[AGENT][NEUTRAL] So our policy does pay towards the copays, deductibles and co-insurance after primary, but let me look into the office visits. Hold on one second, or office setting.
[CUSTOMER][NEUTRAL] No, I don't think it will pay the office visit just for the procedures it would pay for.
[AGENT][NEUTRAL] Right, but it's in an office setting, right?
[CUSTOMER][NEUTRAL] Yes.
[AGENT][NEUTRAL] OK, hold on one moment.
[AGENT][NEUTRAL] Just waiting for the whole document to populate here.
[AGENT][NEUTRAL] They don't. OK, so for the outpatient benefits, um, they don't have the office treatment rider which would have covered any treatment or procedures in the office. Um, they only have the outpatient facility, so this policy doesn't cover in office setting.
[CUSTOMER][NEUTRAL] Alright
[CUSTOMER][NEUTRAL] That it doesn't cover procedures because in the past it did.
[AGENT][NEUTRAL] Not in an office setting. It does cover surgery in a hospital outpatient facility or freestanding outpatient surgery center, but that's not an office setting.
[AGENT][NEUTRAL] That's an outpatient facility.
[CUSTOMER][NEUTRAL] OK, hold on a second, see what it says here.
[CUSTOMER][NEUTRAL] Yeah, I was told that the patient has back in December says um.
[CUSTOMER][NEUTRAL] Um, the patient has benefits in the for the office for procedures, procedures in the office setting up to 2500 for our patients.
[AGENT][NEUTRAL] OK. Well, I do apologize that the wrong information was given, but on their policy, it shows inpatient and outpatient services under outpatient. It only shows a hos.
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] You know, can you look at a claim for 123-2024 to see if that was already um if that was already.
[CUSTOMER][NEUTRAL] Processed
[AGENT][NEUTRAL] Sure, hold on one moment.
[AGENT][NEUTRAL] So I'm not showing a claim on file for [PII] for [PII].
[CUSTOMER][NEUTRAL] So it went out there to American public life.
[CUSTOMER][NEUTRAL] I see.
[CUSTOMER][NEUTRAL] Well, they submitted it on the [PII]. I don't know if that's still too soon to look for the claim.
[AGENT][NEUTRAL] On the [PII], we received something on this, well, for that date of service, we don't have a claim, but from the incoming claims, we received one on [PII] and then [PII]. Um, now, let me see if I can access that to see if that might be your date of service, but it's in processing, so I can't, hold on one moment.
[AGENT][NEUTRAL] It came in on [PII].
[AGENT][NEUTRAL] Here it is.
[CUSTOMER][NEUTRAL] OK, so it just got there then alright.
[AGENT][NEUTRAL] Well, I'm not sure that this is your claim. I'm just trying to access the documents so I can let you know.
[AGENT][NEUTRAL] Yeah, this is a different data service, so this is not your claim. Hold on one second.
[AGENT][NEUTRAL] D of illness.
[AGENT][NEUTRAL] What was the date of service?
[CUSTOMER][NEUTRAL] Um, [PII].
[AGENT][NEUTRAL] Data injury [PII].
[AGENT][NEUTRAL] Data service 123. OK, excuse me.
[AGENT][NEUTRAL] So yes, I do see this data service 123, so this is currently in processing now, um, but
[AGENT][NEUTRAL] So were you wanting to use this to
[CUSTOMER][NEUTRAL] No, OK.
[CUSTOMER][NEUTRAL] May I have a reference number for the call?
[AGENT][NEUTRAL] Sure, there's no call reference number, but you can use my name in today's date, that's [PII] The first initial to my last name is [PII].
[CUSTOMER][NEUTRAL] I just wanna see if that was correct.
[CUSTOMER][NEUTRAL] Uh huh.
[CUSTOMER][POSITIVE] OK, today's date. All right, thank you.
[AGENT][POSITIVE] You're welcome, [PII]. Is there anything else I can help you with today?
[CUSTOMER][NEUTRAL] No, that will be all thanks.
[AGENT][POSITIVE] You're welcome thanks for calling APL bye bye.
[CUSTOMER][NEUTRAL] OK bye bye.