AccountId: 011433970860
ContactId: d38f1f47-c92b-4757-b8e1-5e476c814c87
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 405399 ms
Total Talk Time (AGENT): 148491 ms
Total Talk Time (CUSTOMER): 122638 ms
Interruptions: 0
Overall Sentiment: AGENT=0.4, CUSTOMER=0.2
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/06/25/d38f1f47-c92b-4757-b8e1-5e476c814c87_20250625T16:34_UTC.wav
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[AGENT][NEUTRAL] Thank you for calling American Public Life. This is [PII]. How may I assist you?
[CUSTOMER][NEUTRAL] Uh, my name is [PII]. Last name initial [PII], and I want eligibility and benefits.
[AGENT][NEUTRAL] OK, are you the provider?
[CUSTOMER][NEUTRAL] Oh yes.
[AGENT][NEUTRAL] May I please have a callback number and then the policy number?
[CUSTOMER][NEUTRAL] Callback number is [PII]. The policy number is 024.
[CUSTOMER][NEUTRAL] 563
[CUSTOMER][NEUTRAL] 92
[AGENT][NEUTRAL] Patient's name and date of birth.
[CUSTOMER][NEUTRAL] [PII], [PII].
[AGENT][NEUTRAL] And you're calling in for eligibility and benefits. Is there a specific benefit you're calling in for?
[CUSTOMER][NEUTRAL] Yes, I have some CPD codes for that.
[AGENT][NEUTRAL] Is there for outpatient, inpatient, or an office setting?
[CUSTOMER][NEUTRAL] Uh, done in the specialist office.
[AGENT][POSITIVE] Thank you.
[AGENT][NEUTRAL] And I do have a different policy number. Are you ready for that?
[CUSTOMER][NEUTRAL] Sure.
[AGENT][NEUTRAL] That policy number is showing as 02.
[AGENT][NEUTRAL] 57.
[AGENT][NEUTRAL] 882.
[AGENT][NEUTRAL] And it does show that that policy is currently active with the effective date of [PII].
[AGENT][NEUTRAL] And for office visit benefits, verification of coverage does not guarantee the payment of the claim.
[AGENT][POSITIVE] And I'm pulling those office visit benefits up for you now.
[AGENT][NEUTRAL] And for the member, the office visit fee is not covered up under the policy.
[AGENT][NEUTRAL] And if I did not give the disclaimer verification of coverage does not guarantee the payment of the claim, but for the office procedure, the member does have up to $6000 per calendar year, and that will go towards the procedure rendered within the office setting.
[AGENT][NEUTRAL] And that does apply to the major medical primary.
[AGENT][NEUTRAL] Deductible, coinsurance, or co-pay.
[CUSTOMER][NEUTRAL] So allowed amount is $600 per year, right?
[AGENT][NEUTRAL] The member has up to $6000 per calendar year.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] It is allowed amount or out of pocket max?
[AGENT][NEUTRAL] That is the maximum amount that we will pay out towards the major medical deductible, co-insurance, or co-pay.
[CUSTOMER][NEUTRAL] OK, so the person does not have any deductible or out of pocket max, right?
[AGENT][NEUTRAL] For us, no, but you have to check with their primary insurance.
[CUSTOMER][NEUTRAL] Yeah, primary is uh.
[CUSTOMER][NEUTRAL] UC. I have already verified that. And so you are telling that uh you are saying that office visit is not covered, right?
[AGENT][NEUTRAL] Correct, the office visit fee is not covered.
[CUSTOMER][NEUTRAL] Only the procedures done in the specialist office visit are covered, right?
[AGENT][NEUTRAL] Yes.
[CUSTOMER][NEUTRAL] OK. Is there any authorization required for any of the procedures?
[AGENT][NEUTRAL] No all this required.
[CUSTOMER][NEUTRAL] And also the no rep uh no referral is required right from PCP.
[AGENT][NEUTRAL] I'm sorry, what was that again?
[CUSTOMER][NEUTRAL] Uh, the referral from PCP is also not required.
[AGENT][NEUTRAL] No, if anything needs to be done, you would check with the primary insurance.
[CUSTOMER][NEUTRAL] OK. And what is the type of plan?
[AGENT][NEUTRAL] This is their secondary to the major medical.
[CUSTOMER][NEUTRAL] And no type of plan like HMO PPO POS, which one?
[AGENT][NEUTRAL] We're not considered a major medical. This is just a secondary or supplemental.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Supplement plan.
[CUSTOMER][NEUTRAL] So, let me confirm, offices, it is not covered. Allowed amount for the procedures is 6000 per year. Uh, is there any mat amount?
[AGENT][NEUTRAL] Let me check that for you.
[AGENT][NEUTRAL] As of right now, it is showing that the member has used the total amount of $620.59.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Uh, yeah, can you please spell out your name?
[AGENT][NEUTRAL] Yes, it is spelled [PII] R.
[AGENT][NEUTRAL] [PII] with the last initial of [PII] in today's date as the call reference.
[CUSTOMER][NEUTRAL] Uh, just a moment.
[CUSTOMER][NEUTRAL] Is uh the person is it, uh, subscriber or someone else?
[AGENT][NEUTRAL] You're asking if that member is a subscriber?
[CUSTOMER][NEUTRAL] Yeah
[AGENT][NEUTRAL] They're a dependent listed on the policy.
[CUSTOMER][NEUTRAL] Subscriber or not.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] And the dependent is father, right?
[AGENT][NEUTRAL] The dependent is [PII].
[CUSTOMER][NEUTRAL] The name is [PII].
[CUSTOMER][NEUTRAL] And the subscriber is [PII].
[AGENT][NEUTRAL] Yes.
[CUSTOMER][NEUTRAL] Am I correct?
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][POSITIVE] Thank you for the details.
[AGENT][NEUTRAL] Is there anything else that I can assist you with today? Don't go ahead, let me check that for you.
[CUSTOMER][NEUTRAL] Is there any group number?
[CUSTOMER][NEUTRAL] Oh, yeah.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] The group number is 26258.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][POSITIVE] Thank you for the details. Have a great rest of the day.
[AGENT][POSITIVE] You're welcome and thank you for calling American Public Life, [PII]. Have a great day.
[CUSTOMER][NEUTRAL] You too