AccountId: 011433970860
ContactId: e0a2b949-77b0-491e-a7d8-c430254ed631
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 235699 ms
Total Talk Time (AGENT): 78559 ms
Total Talk Time (CUSTOMER): 71156 ms
Interruptions: 1
Overall Sentiment: AGENT=1.3, CUSTOMER=1.1
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/05/30/e0a2b949-77b0-491e-a7d8-c430254ed631_20250530T15:54_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 [PII]. I'm calling from Doctor [PII]'s office. I need benefits on a patient's gap plan.
[AGENT][POSITIVE] All right. Happy to check benefits. What's your policy number?
[CUSTOMER][NEUTRAL] 02249239
[AGENT][NEUTRAL] OK, let me pull that up here and then can I grab your first name for documentation?
[CUSTOMER][NEUTRAL] It's [PII], that's [PII]
[AGENT][POSITIVE] Thank you very much.
[AGENT][NEUTRAL] Patient's name and date of birth?
[CUSTOMER][NEUTRAL] [PII], [PII].
[AGENT][NEUTRAL] Mhm.
[AGENT][NEUTRAL] Thank you. So, patient is active. Effective date is [PII]. We are the members secondary insurance, so this does cover deductible, co-pay, co-insurance of primary does not.
[CUSTOMER][NEUTRAL] Right, so with this patient's plan, um, it's never covered in the past procedures rendered in the doctor's office.
[AGENT][NEUTRAL] OK, let me look at this.
[CUSTOMER][NEUTRAL] So could you check and see if it covers procedures in a doctor's office? Maybe if something changed this year?
[AGENT][NEUTRAL] Yeah, let me take a look.
[AGENT][NEUTRAL] um
[AGENT][NEUTRAL] OK, so it does say under, it has a writer on here. It says physician outpatient treatment. It says treatment in hospital outpatient facility, emergency care clinic, urgent care, or physician's office. Maximum benefit, $25 per visit with a maximum of 4 visits per covered person per calendar year.
[CUSTOMER][NEUTRAL] So then that means that means that the $25 will go towards the visit to help towards the the copay. That's what that means for 4 visits a year. That's what I was telling the other representative who kept telling me that it goes towards the procedures because the the this the plan that this patient has does not cover procedures in the office.
[AGENT][POSITIVE] Correct, yes, ma'am. Yeah.
[AGENT][NEUTRAL] Mm.
[CUSTOMER][NEUTRAL] So does he still have those 4 visits where they pay up to $25 or does he, uh, or have they, he's exhausted those?
[AGENT][NEUTRAL] I can double check. Let me take a look here, one second.
[AGENT][NEUTRAL] Looks like they have the full uh remaining. They haven't used anything for the year thus far.
[CUSTOMER][NEUTRAL] OK, so then he has up to $25 for 4 visits per year, is that correct? That they pay towards the office visit.
[AGENT][NEUTRAL] Mhm, yes.
[AGENT][POSITIVE] Correct.
[CUSTOMER][NEUTRAL] OK, alright, so let me have a reference number for the call.
[AGENT][NEUTRAL] That's my name with today's date. My name again is [PII] and my last initial is [PII].
[CUSTOMER][NEUTRAL] [PII] or without?
[AGENT][NEUTRAL] With an [PII]
[CUSTOMER][POSITIVE] OK thank you bye bye.
[AGENT][POSITIVE] You're welcome. Have a good day, [PII].
[CUSTOMER][POSITIVE] Thank you you too bye bye.