AccountId: 011433970860
ContactId: e428c970-2fda-4db7-b453-821e437a1278
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 264420 ms
Total Talk Time (AGENT): 119342 ms
Total Talk Time (CUSTOMER): 95156 ms
Interruptions: 2
Overall Sentiment: AGENT=0.5, CUSTOMER=0.2
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/03/11/e428c970-2fda-4db7-b453-821e437a1278_20250311T14:38_UTC.wav
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[AGENT][NEUTRAL] Thank you for calling APL. This is [PII]. How may I help you?
[CUSTOMER][NEUTRAL] Yes, hi, I'm calling from Doctor [PII]'s office. I need to go with benefits on a patient, please.
[AGENT][NEUTRAL] OK, I can help you with benefits. um, can I please get your name and your callback number?
[CUSTOMER][NEUTRAL] It's [PII] that's [PII].
[AGENT][NEUTRAL] Thank you, Ms. [PII]. And what is the patient's name, date of birth, and policy number?
[CUSTOMER][NEUTRAL] [PII] 0161156 ML 8.
[AGENT][NEUTRAL] OK, let me look that up real quick.
[AGENT][NEUTRAL] OK, I may have missed a digit. Can you please repeat the policy number for me?
[CUSTOMER][NEUTRAL] 0161156 ML 8.
[AGENT][NEUTRAL] Hm, OK.
[AGENT][NEUTRAL] Yeah, that policy number is not pulling up for me. Do you see another number?
[CUSTOMER][NEUTRAL] hold on.
[AGENT][NEUTRAL] Yes, ma'am.
[CUSTOMER][NEUTRAL] 0
[CUSTOMER][NEUTRAL] It's 01611565 ML 8.
[AGENT][NEUTRAL] OK, let me try it with the extra 5 in there.
[AGENT][NEUTRAL] OK, I think we have her now.
[CUSTOMER][NEUTRAL] OK, so
[AGENT][NEUTRAL] All right. And um,
[AGENT][NEUTRAL] Let me pull her up and [PII] does have uh active policy.
[AGENT][NEUTRAL] The effective date for [PII] is [PII].
[AGENT][NEUTRAL] And this is just to verify coverage. 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.
[AGENT][NEUTRAL] The insured has an inpatient calendar year benefit amount of $2500 and they have an outpatient calendar year benefit amount of $1500 to go towards deductible copay or co-insurance.
[CUSTOMER][NEUTRAL] OK, so
[CUSTOMER][NEUTRAL] It covers it covers procedures in the office up to 1500.
[AGENT][NEUTRAL] $1500. Um, let me see, is this an office visit, like a doctor's office?
[CUSTOMER][NEUTRAL] No procedures in the office, no procedures in the office, it covers up to 1500.
[AGENT][POSITIVE] Yes, to help towards deductible, co-pay or co-insurance.
[CUSTOMER][NEUTRAL] Right, if the patient has a deductible, if he does the procedure in the office, it would go towards the deductible. So this gap plan will cover the procedures in the office up to 1500. So may I have a reference number for the call?
[AGENT][NEUTRAL] Yeah, let me check.
[AGENT][NEUTRAL] Yes, but I'm going to check to see if they have office visits on this policy because it goes by.
[CUSTOMER][NEUTRAL] Uh, it doesn't have officers and policies. It only has for the procedures.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] All right.
[CUSTOMER][NEUTRAL] Office visit is something different from the procedures.
[CUSTOMER][NEUTRAL] It has for the procedures.
[AGENT][NEUTRAL] Yes, but this
[AGENT][NEUTRAL] I understand, but this policy doesn't go by the procedure, it goes by the facility.
[CUSTOMER][NEUTRAL] OK, so I verified it back on [PII], so they, I was told that the gap plan covers procedures that are rendered in the office up to 1500. So the patient does a biopsy in the office, it should be covered because that biopsy will go towards the patient's deductible.
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] You just finished saying that it covers the deductibles, so that's it covers procedures in the office. It doesn't cover an office visit. The office visit is separate. That's a $30 co-pay.
[AGENT][NEUTRAL] OK. Yes, ma'am.
[AGENT][NEUTRAL] Yes ma'am.
[AGENT][POSITIVE] OK, I understand what you're saying now yes ma'am, you're correct.
[CUSTOMER][NEUTRAL] Yeah, OK, yeah, so.
[CUSTOMER][NEUTRAL] May I have a reference number for the call?
[AGENT][NEUTRAL] Yes, you can use my name [PII] and today's date.
[CUSTOMER][POSITIVE] All right great thank you bye bye.
[AGENT][POSITIVE] You're welcome bye bye, have a wonderful day and thanks for calling.
[CUSTOMER][NEUTRAL] Bye.