AccountId: 011433970860
ContactId: d85a4baa-701e-410d-ab8f-031c38be86fa
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 252089 ms
Total Talk Time (AGENT): 92340 ms
Total Talk Time (CUSTOMER): 65900 ms
Interruptions: 1
Overall Sentiment: AGENT=0.3, CUSTOMER=1.5
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/03/24/d85a4baa-701e-410d-ab8f-031c38be86fa_20250324T16:14_UTC.wav
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[AGENT][NEUTRAL] Thank you for calling APL. This is [PII]. How can I help you?
[CUSTOMER][NEUTRAL] Yes, hi, I'm calling from Doctor [PII]'s office. I'm calling to see if patient has benefits with the with, um, her gap plan.
[AGENT][POSITIVE] Um, yes, ma'am. I can assist you with benefits. Um, first, can I get your name and a good callback number in case we're disconnected?
[CUSTOMER][NEUTRAL] It's [PII] and that's [PII].
[AGENT][NEUTRAL] OK. Thank you, [PII]. Now I need the policy number, please.
[CUSTOMER][NEUTRAL] Um, yes, the policy number is 022-05763.
[AGENT][NEUTRAL] And please verify the patient's name and date of birth.
[CUSTOMER][NEUTRAL] Patient's name is [PII]. Date of birth is [PII].
[AGENT][NEUTRAL] Thank you and just let me advise you that verification of coverage does not guarantee payment of claims. Um, the effective date on this policy was [PII] and the policy is still active. And on which benefit do you need to verify?
[CUSTOMER][NEUTRAL] So the patient has a deductible with her primary plan. Any procedures rendered in the office would be her responsibility. Does this, does this gap plan cover procedures that may be rendered in the office, such as biopsies, not the office visit, just the procedures.
[AGENT][NEUTRAL] Mm.
[AGENT][NEUTRAL] OK, let's see.
[AGENT][NEUTRAL] OK, no, ma'am. I'm showing for services provided in office, there's no coverage.
[CUSTOMER][NEUTRAL] So the patient doesn't have an office writer?
[CUSTOMER][NEUTRAL] If the if the doctor does a biopsy, it's not covered or?
[AGENT][NEUTRAL] No, I'm not
[AGENT][NEUTRAL] Right. It's not set up in the system. Let me pull the image real quick.
[AGENT][NEUTRAL] Make sure, one moment.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] OK, no, ma'am. There's no coverage in office under this policy.
[CUSTOMER][NEUTRAL] So the patient only has coverage for hospital?
[AGENT][NEUTRAL] Yes, I'm only showing hospital, urgent care facilities, um, physical therapy and cancer treatment is covered if that's done in the office.
[CUSTOMER][NEUTRAL] No, but so office procedures aren't covered, OK.
[AGENT][NEUTRAL] That's correct. Yes, ma'am, unless for cancer treatment or physical therapy.
[CUSTOMER][NEUTRAL] All right, may I have, may I have a reference, OK.
[CUSTOMER][NEUTRAL] OK, so may I have a reference number for the call? Outpatient is outpatient. Did they mention outpatient treatment center?
[AGENT][NEUTRAL] Yes, so
[AGENT][NEUTRAL] Yeah, for outpatient treatments done in office, there's only coverage for physical therapy and cancer treatment.
[AGENT][NEUTRAL] But any other outpatient um services um must be done in a hospital or um surgery center.
[CUSTOMER][NEUTRAL] Oh, OK.
[CUSTOMER][NEUTRAL] OK, so what's the reference number?
[AGENT][NEUTRAL] So the reference number, you can use my name and today's date. My name is [PII]. It's spelled [PII] Last initial is [PII] and today's date. Is there anything else that I can assist you with?
[CUSTOMER][POSITIVE] No, that's all thank you all right bye bye.
[AGENT][NEUTRAL] Mhm. Thank you, [PII], for calling APL. Mhm. Bye.
[CUSTOMER][POSITIVE] Thank you bye.
[CUSTOMER][POSITIVE] You're welcome bye bye.