AccountId: 011433970860
ContactId: d392ad1c-8699-4d6f-b1fe-716a5ab473a4
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 270480 ms
Total Talk Time (AGENT): 118403 ms
Total Talk Time (CUSTOMER): 110952 ms
Interruptions: 0
Overall Sentiment: AGENT=1.3, CUSTOMER=0.7
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/03/13/d392ad1c-8699-4d6f-b1fe-716a5ab473a4_20250313T15:17_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] Hi [PII], my name is [PII]. I am calling from a doctor's office. We were presented with an APL, uh, insurance card today, and I needed to get some information if I could.
[AGENT][NEUTRAL] OK, well, I can definitely assist you with the member's policy and [PII], may I have a good contact number in case we're disconnected?
[CUSTOMER][NEUTRAL] Yes, [PII].
[AGENT][NEUTRAL] Thank you for that. And may I have the member's policy number?
[CUSTOMER][NEUTRAL] 02598202.
[AGENT][POSITIVE] Thank you for that and hold on one moment.
[AGENT][NEUTRAL] And can you verify the member's first and last name and date of birth?
[CUSTOMER][NEUTRAL] Yes, the, well, the name on the card is, uh, [PII]. However, our patient is [PII] and her date of birth is [PII].
[AGENT][NEUTRAL] Thank you for that and all the information provided is a verification of benefits, not a guarantee of payment. And I am showing that the policy is active. It's been effective since [PII]. And um how may I assist you today with the policy?
[CUSTOMER][NEUTRAL] Um, I'm calling for benefits information for, um, well, first I need to see if you, if we're in network with this policy, um.
[CUSTOMER][NEUTRAL] Do you need our tax ID?
[AGENT][NEUTRAL] Um, no, so the policy is a hospital indemnity policy. So it does have the PPO network through multi-plan, but Multiplan is a different company. We don't have access to their list of providers. I can give you their phone number or their website to see if you're in network with them.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][POSITIVE] Let's just go, I guess go ahead and get the benefits um.
[CUSTOMER][NEUTRAL] Is she, uh, for an office visit? I'm sorry, go ahead.
[AGENT][NEUTRAL] What
[AGENT][NEUTRAL] Mhm.
[AGENT][NEUTRAL] No, no, I
[CUSTOMER][NEUTRAL] Physicians often
[CUSTOMER][NEUTRAL] I'm sorry.
[AGENT][NEUTRAL] It's OK, go ahead.
[CUSTOMER][NEUTRAL] OK, so for a physician's office visit.
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Uh, what would her responsibility be?
[AGENT][NEUTRAL] So, for the physician office visit, the policy would pay up to $50 per visit with a max of 4 visits per calendar year.
[CUSTOMER][NEUTRAL] OK, um, has she had any visits yet? I guess not. It just was.
[AGENT][NEUTRAL] Let's see.
[AGENT][NEUTRAL] Hold on one second, let's see.
[AGENT][NEUTRAL] No, ma'am, I'm not showing any of the benefits have been used yet.
[CUSTOMER][NEUTRAL] OK, and then just another side question, so if we charge if an office visit is um.
[CUSTOMER][NEUTRAL] The allowable amount is $200 you guys will pay $50 and then she would be responsible for the other $150?
[AGENT][NEUTRAL] Well, we don't determine patient responsibility because we're not a major medical insurance company. So if there is an outstanding balance after we apply, um, you know, for the policy, then it would just be whatever your uh procedures are for remaining balances or outstanding balances if there is not another insurance because we wouldn't have that information.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK, and um.
[CUSTOMER][NEUTRAL] Your claims go to IMA for her insurance card, is that right?
[AGENT][POSITIVE] Yes, that's correct. Mhm.
[CUSTOMER][NEUTRAL] OK, now if she were to have a surgical procedure.
[CUSTOMER][NEUTRAL] Uh, I can give you a CPT code if that helps to see what your maximum payment would be.
[AGENT][NEUTRAL] Well, our policies, um, so our policies aren't really broken down by the, by what's done, it's more like place of service. So if she does have any surgery, um, if it's
[CUSTOMER][NEUTRAL] It'll be
[CUSTOMER][NEUTRAL] Uh, it'll be in an office.
[AGENT][NEUTRAL] OK, so she's, um, the policy will pay up to $125.02 times per calendar year towards the in-office surgery.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK, um,
[CUSTOMER][POSITIVE] I think that's all I need I appreciate your help.
[AGENT][POSITIVE] You're very welcome. Well, thanks for calling APL and I hope you have a great day.
[CUSTOMER][POSITIVE] Thank you you as well.
[AGENT][POSITIVE] Thank you. Bye-bye.
[CUSTOMER][NEUTRAL] Uh