AccountId: 011433970860
ContactId: d88c5c6c-fc76-4225-8cc8-9636fa59f184
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 185559 ms
Total Talk Time (AGENT): 85697 ms
Total Talk Time (CUSTOMER): 69922 ms
Interruptions: 0
Overall Sentiment: AGENT=1.9, CUSTOMER=0.3
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/02/04/d88c5c6c-fc76-4225-8cc8-9636fa59f184_20250204T22:20_UTC.wav
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[AGENT][POSITIVE] Good afternoon. Thank you for calling APL. My name is [PII]. How may I help you?
[CUSTOMER][NEUTRAL] Hi, good afternoon. My name is [PII]. I'm calling from a provider's office of Orthoel, um, just in case to give you a call back number is [PII].
[AGENT][POSITIVE] Thank you for that. And how may I assist you today, [PII]?
[CUSTOMER][NEUTRAL] Yeah, so I was just calling today to verify for a mutual patient, um, for the benefits for the gap insurance with APL. Um, I can give you the patient's name and date of birth or the ID number as well.
[AGENT][NEUTRAL] OK, may I have the member's policy number?
[CUSTOMER][NEUTRAL] Yes, it's gonna be 02353122 ML 8.
[AGENT][POSITIVE] Thank you for that. Hold on one moment.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] And can you verify the member's first and last name and date of birth?
[CUSTOMER][NEUTRAL] Yes, it's gonna be [PII]. The last name is [PII], which is [PII] He has another last name just in case, which is [PII], and his 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. So I am showing the policy is active. It's been effective since [PII].
[AGENT][NEUTRAL] And did you want to go over outpatient benefits today?
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Um, so I just, I just wanted to verify the benefits that this covers from the primary insurance from UnitedHealthcare as far as deductible or copay.
[AGENT][NEUTRAL] So our policies pay towards the copay, deductible and co-insurance of coverage charges after primary, depending on if it's inpatient or outpatient, there's a calendar, well, it could be different terms, but for this policy, it's calendar year. Um, so if you are considered outpatient, it will be up to $2000 per calendar year that they can use for outpatient.
[CUSTOMER][NEUTRAL] Mm, oh, OK, so yeah, like for an urgent care clinic office visit.
[AGENT][NEUTRAL] Oh yes, OK, so for urgent care, it would be that um $2000. Now they do also have the office treatment rider, so any treatment done in the in in the office setting, as long as it's not cosmetic um could be covered under or up to that $2000 per year. Did you want me to see if they've used any for the year?
[CUSTOMER][NEUTRAL] Uh, yeah, just to double check.
[AGENT][NEUTRAL] OK, hold on one moment.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] OK, so none of the benefits have been used for the year, so she still has that full 2000 to use.
[CUSTOMER][NEUTRAL] Yeah
[CUSTOMER][NEUTRAL] OK perfect and so um it's OK what was your name again sorry?
[AGENT][NEUTRAL] Or he still, sorry.
[AGENT][NEUTRAL] My name is [PII].
[CUSTOMER][NEUTRAL] OK perfect and then the call reference is your name and today's date?
[AGENT][POSITIVE] Yes, that's correct.
[CUSTOMER][POSITIVE] Thank you so much alrighty thank you.
[AGENT][POSITIVE] You're welcome. Thanks for calling APL and I hope you have a great day.
[CUSTOMER][NEUTRAL] You too bye.
[AGENT][NEUTRAL] Bye bye.