AccountId: 011433970860
ContactId: dd6ddb85-9f83-48e2-813e-7b79e1aba498
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 413250 ms
Total Talk Time (AGENT): 119140 ms
Total Talk Time (CUSTOMER): 180408 ms
Interruptions: 3
Overall Sentiment: AGENT=0.2, CUSTOMER=0.8
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/04/25/dd6ddb85-9f83-48e2-813e-7b79e1aba498_20250425T13:32_UTC.wav
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[AGENT][NEUTRAL] Good morning. Thank you for calling APL. This is [PII]. May I help you?
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] Hi [PII], I'm calling from Dial Medical Center, um, just to ask you a couple questions about the benefits that the insurance covers.
[AGENT][NEUTRAL] OK, may I ask who's calling?
[CUSTOMER][NEUTRAL] [PII].
[CUSTOMER][NEUTRAL] Well.
[AGENT][NEUTRAL] And do you have a phone number I can get in case we get disconnected I can call you back?
[CUSTOMER][NEUTRAL] Yeah
[CUSTOMER][NEUTRAL] OK, yep, it's gonna be [PII].
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] Do you have the policy number?
[CUSTOMER][NEUTRAL] Uh yes, I do. It's gonna be 025792991.
[AGENT][NEUTRAL] Thank you, [PII]. Hold on one moment, please.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Yeah
[CUSTOMER][NEUTRAL] And
[AGENT][NEUTRAL] And what's the patient's name?
[CUSTOMER][NEUTRAL] Uh, the [PII].
[AGENT][NEUTRAL] And her date of birth?
[CUSTOMER][NEUTRAL] Um, it's going to be [PII].
[AGENT][POSITIVE] Thank you, [PII], and you were needing benefits?
[CUSTOMER][NEUTRAL] Yeah, it's just, it's just for one. Can you spell your first name for me please?
[AGENT][POSITIVE] Yes, I can spell it for you. It's [PII]
[CUSTOMER][NEUTRAL] Yeah, so.
[CUSTOMER][NEUTRAL] Last initial is?
[AGENT][NEUTRAL] S
[CUSTOMER][POSITIVE] That perfect. OK, alright, um, when is the plan's effective date?
[AGENT][NEUTRAL] [PII].
[CUSTOMER][POSITIVE] Perfect. [PII] is there a termination date?
[AGENT][NEUTRAL] No, ma'am. It's still active.
[CUSTOMER][NEUTRAL] No, perfect, um, what's the plan's payer ID?
[AGENT][NEUTRAL] 60801.
[CUSTOMER][NEUTRAL] You said 608-801?
[AGENT][NEUTRAL] 60801.
[CUSTOMER][NEUTRAL] OK, perfect. Does the is the PCP assigned required?
[AGENT][NEUTRAL] Is the what now?
[CUSTOMER][NEUTRAL] The, the pro the, is there a copayment amount for the offices?
[AGENT][NEUTRAL] Hold on, let me see if she has an office visit.
[AGENT][NEUTRAL] Any benefits given over the phone is not a guarantee of payment.
[AGENT][NEUTRAL] This policy does coordinate with the primary insurance, whatever the primary applies to the deductible, co-pay or co-insurance. That's what we pick up on this policy. Let me look and see.
[AGENT][NEUTRAL] If she has the office visit runner.
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] Yeah.
[AGENT][NEUTRAL] I'm not showing it covers office visit. It covers treatment in the office visit, but I'm not showing it covers the actual office visit.
[CUSTOMER][NEUTRAL] Mm
[CUSTOMER][POSITIVE] Perfect. Doesn't.
[CUSTOMER][NEUTRAL] Cover
[CUSTOMER][NEUTRAL] Office visits.
[CUSTOMER][NEUTRAL] OK, um, does the plan have a car insurance?
[AGENT][NEUTRAL] No, it just coordinates with the primary insurance.
[CUSTOMER][NEUTRAL] OK. Um, does this plan cover X-rays, ultrasounds, MRI CTs?
[AGENT][NEUTRAL] Yes.
[CUSTOMER][NEUTRAL] Um, is it, um, deductible insurance or co-play applies?
[AGENT][NEUTRAL] It coordinates with the primary insurance.
[CUSTOMER][NEUTRAL] Do the MRIs and CT scans require, um, require prior authorization?
[AGENT][NEUTRAL] It does not. This is a secondary policy.
[CUSTOMER][NEUTRAL] I just don't know.
[CUSTOMER][NEUTRAL] OK, does does the plan cover mental health?
[AGENT][NEUTRAL] Yes.
[CUSTOMER][NEUTRAL] Perfect. OK, let me see here, um, the pat, uh, when did the patient's benefits renew?
[CUSTOMER][NEUTRAL] At the beginning of the year or what month?
[AGENT][NEUTRAL] Oh, that I'm not sure.
[AGENT][NEUTRAL] I'm not sure when the policy renews.
[CUSTOMER][NEUTRAL] OK, does the plan have a limit in office visits per calendar year?
[AGENT][NEUTRAL] It does not cover office visits.
[CUSTOMER][POSITIVE] Perfect. Did the patient meet his or hers preventive benefit of the year?
[AGENT][NEUTRAL] It's not a preventative benefit. This is just a secondary policy.
[CUSTOMER][NEUTRAL] Yeah, yeah, I'm just asking you the same questions as if they would ask the primary, so I'm just gonna put no.
[AGENT][NEUTRAL] Yeah, and most of it doesn't apply because this policy coordinates with the primary.
[CUSTOMER][NEUTRAL] Um, yeah.
[CUSTOMER][NEUTRAL] Doesn't apply. Perfect. Um, does the policy cover annual preventative visitor services?
[AGENT][NEUTRAL] No.
[CUSTOMER][NEUTRAL] No, perfect, OK, and then this applies.
[AGENT][NEUTRAL] And if the major medical doesn't pay, we do not pay.
[CUSTOMER][NEUTRAL] True.
[CUSTOMER][POSITIVE] Alright, perfect.
[CUSTOMER][NEUTRAL] OK, um let me see here, does the plan have a yearly deductible?
[AGENT][NEUTRAL] Mhm
[AGENT][NEUTRAL] Yeah
[AGENT][NEGATIVE] No, it does not.
[CUSTOMER][NEUTRAL] No, OK.
[CUSTOMER][POSITIVE] Perfect. And then is the the prime uh the PCP assigned required like the primary doctor um required to be assigned to the insurance?
[AGENT][NEUTRAL] No, this doesn't have a list of providers. It mirrors the major medical.
[CUSTOMER][NEUTRAL] OK, and then the referrals to specialist are required or no? Or it doesn't apply?
[AGENT][NEUTRAL] No.
[AGENT][NEGATIVE] It doesn't apply.
[CUSTOMER][POSITIVE] No, perfect.
[CUSTOMER][NEUTRAL] Alright, and then can I have the call reference number?
[AGENT][NEUTRAL] We do not have call reference numbers. You can use my name in today's date.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][POSITIVE] Perfect. So I'm gonna put here, uh, and then today's date is [PII]. Perfect, thank you, honey. I really appreciate it.
[AGENT][POSITIVE] Thank you, [PII], for calling APL. You have a good day. Bye-bye.
[CUSTOMER][NEUTRAL] Alright you as well.