AccountId: 011433970860
ContactId: dad8aa52-c35b-48cf-90c0-59d0dae37823
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 422799 ms
Total Talk Time (AGENT): 172710 ms
Total Talk Time (CUSTOMER): 144185 ms
Interruptions: 2
Overall Sentiment: AGENT=0.6, CUSTOMER=0.7
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/04/01/dad8aa52-c35b-48cf-90c0-59d0dae37823_20250401T19:20_UTC.wav
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[AGENT][NEUTRAL] Thank you for calling APL. This is [PII]. How may I help you?
[CUSTOMER][NEUTRAL] Hi [PII], my name is [PII]. Last initial [PII], and I'm here because I need to check some benefits for a patient.
[AGENT][NEUTRAL] OK, [PII], I can help you with benefits for a patient. Can you please give me your callback number and the name of the facility you're calling from?
[CUSTOMER][NEUTRAL] Sure, the facility name is Vital MD Group Holding and the number is [PII].
[AGENT][NEUTRAL] Thank you, sir. And what is the patient's name, date of birth, and policy number?
[CUSTOMER][NEUTRAL] It is [PII]. Date of birth is [PII] and the
[CUSTOMER][NEUTRAL] ID number is 02404599 [PII].
[AGENT][NEUTRAL] OK, let me look up the policy real quick.
[CUSTOMER][NEUTRAL] Yeah
[AGENT][NEUTRAL] OK, I do have
[AGENT][NEUTRAL] A sale pulled up and I do see that they do have an active policy. The effective date of the policy is [PII].
[AGENT][NEUTRAL] And this is just to verify benefits. It's not a guarantee of payment. This is a supplemental insurance policy that's billed secondary to the primary. It helps with deductible, co-pay, and co-insurance.
[CUSTOMER][NEUTRAL] Yeah.
[AGENT][NEUTRAL] The insured has an inpatient calendar year benefit amount of $1000 and then they also have an outpatient per calendar day benefit of $500 to go towards deductible, co-pay or co-insurance.
[CUSTOMER][NEUTRAL] OK, so
[CUSTOMER][NEUTRAL] This plan cover they say a maximum of $3000 sorry?
[AGENT][NEUTRAL] No.
[AGENT][NEUTRAL] Inpatient is $100 per calendar year and outpatient is per calendar day of $500.
[CUSTOMER][NEUTRAL] Could you
[CUSTOMER][NEUTRAL] OK. And the policy is annual, right?
[CUSTOMER][NEUTRAL] And
[AGENT][NEUTRAL] Is what, sir?
[CUSTOMER][NEUTRAL] I
[AGENT][NEUTRAL] Can you repeat the question?
[CUSTOMER][NEUTRAL] And sorry for that and I just have one question so for it is $500 per day per visit um.
[AGENT][NEUTRAL] Per calendar.
[CUSTOMER][NEUTRAL] Per calendar day, OK.
[AGENT][NEUTRAL] For outpatient benefits, for deductible, co-pay or co-insurance.
[CUSTOMER][NEUTRAL] Got it. Um, does this plan has maybe deductible on another pocket?
[AGENT][NEUTRAL] No. Um, let me see if it has any deductible at all. No, sir.
[CUSTOMER][NEUTRAL] No
[CUSTOMER][NEUTRAL] OK, got it. So this one's covered for a patient $500 per calendar day.
[CUSTOMER][NEUTRAL] Just give me a second.
[AGENT][NEUTRAL] Yes, for outpatient.
[CUSTOMER][NEUTRAL] OK, and that's for the specialist office B surgery and X-ray, right?
[AGENT][NEUTRAL] Uh, now, let me check and see their benefits to see if they have office visits on their policy.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] It's gonna be just a second while I pull it in.
[CUSTOMER][POSITIVE] Sure, take your time don't worry thank you so much for your time.
[AGENT][POSITIVE] Oh, you're welcome. I want to make sure you have good information.
[CUSTOMER][POSITIVE] Thank you so much.
[AGENT][POSITIVE] You're welcome.
[AGENT][NEUTRAL] OK, so this policy does not cover office visits. It will work for an ER urgent care center, MRI imaging center, or an ambulatory center.
[CUSTOMER][NEUTRAL] Got it. Um, for the surgery and X-ray?
[AGENT][NEUTRAL] So they're gonna have an outpatient surgery, is that correct?
[CUSTOMER][NEUTRAL] How is the sunshine.
[CUSTOMER][NEUTRAL] Yes. Opatient surgery and X-ray, minor labs.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] Right, will be done in an ambulatory center, is that correct? Is it a outpatient facility that's
[CUSTOMER][NEUTRAL] In office at office.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] Uh, let me see if they have surgery benefits.
[CUSTOMER][NEUTRAL] So.
[CUSTOMER][NEUTRAL] He
[AGENT][NEUTRAL] It's gonna be just a second, let me pull it in.
[CUSTOMER][NEUTRAL] [PII].
[CUSTOMER][NEUTRAL] X Y M T.
[CUSTOMER][NEUTRAL] Yeah
[CUSTOMER][POSITIVE] Yes your X-ray.
[CUSTOMER][NEUTRAL] M
[CUSTOMER][NEUTRAL] Yeah
[CUSTOMER][NEUTRAL] A.
[AGENT][NEUTRAL] Are they gonna be inpatient for the surgery or are they gonna be outpatient for the surgery?
[CUSTOMER][NEUTRAL] Outpatient office seating.
[AGENT][NEUTRAL] OK. OK. Let me check. Yeah, they do not have office visits on their policy.
[CUSTOMER][NEUTRAL] Yeah
[CUSTOMER][NEUTRAL] Yeah
[CUSTOMER][NEUTRAL] But for surgery.
[AGENT][NEUTRAL] So it
[AGENT][NEUTRAL] It would have to be in an ambulatory center, an ER, or an urgent care center.
[CUSTOMER][NEUTRAL] Uh, well
[CUSTOMER][NEUTRAL] OK, so for the services or the procedures done at the specialist office at the office, they are not covered, right?
[AGENT][NEUTRAL] Right.
[AGENT][NEUTRAL] Unless it's an ambulatory center.
[CUSTOMER][POSITIVE] Got it thank you so much for that.
[CUSTOMER][NEUTRAL] OK, got it.
[CUSTOMER][POSITIVE] OK, got it. Thank you so much for that information. May I have the reference number?
[AGENT][NEUTRAL] Yes, sir. You can use my name, [PII] and today's date.
[CUSTOMER][NEUTRAL] Yeah
[CUSTOMER][NEUTRAL] No
[CUSTOMER][NEUTRAL] For
[CUSTOMER][POSITIVE] OK, got it. Sorry. Thank you so much for your hold and your time. Have a wonderful day. God bless you.
[AGENT][POSITIVE] God bless you too, [PII]. Thank you for calling today. I'm glad I was able to help you. Thank you for calling APL.
[CUSTOMER][NEUTRAL] And that