AccountId: 011433970860
ContactId: e677b6c2-83d7-438f-b372-dc2c792a3448
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 223009 ms
Total Talk Time (AGENT): 116715 ms
Total Talk Time (CUSTOMER): 55877 ms
Interruptions: 0
Overall Sentiment: AGENT=0.5, CUSTOMER=0.7
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/04/04/e677b6c2-83d7-438f-b372-dc2c792a3448_20250404T20:09_UTC.wav
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[AGENT][POSITIVE] Thank you for calling American Public Life. This is [PII]. How can I help you?
[CUSTOMER][NEUTRAL] Uh yes, um, I was calling for eligibility and benefits for a patient.
[AGENT][NEUTRAL] OK, I can help you with that. May I have your name and a callback number?
[CUSTOMER][NEUTRAL] [PII] and um [PII].
[AGENT][NEUTRAL] Thank you. And the policy number you're calling on, [PII]?
[CUSTOMER][NEUTRAL] 02519450
[AGENT][NEUTRAL] Patient's name and date of birth?
[CUSTOMER][NEUTRAL] [PII], um, her birthday is.
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] OK, thank you so much for verifying her account, and you did say benefits, is this going to be for outpatient benefits?
[CUSTOMER][NEUTRAL] Uh, yes, outpatient.
[AGENT][NEUTRAL] OK, please be advised verifying benefits is not guarantee payment. Uh, I show the policy with us. It's been effective since [PII]. It is still active. I show for outpatient benefits, the policy.
[AGENT][NEUTRAL] I make sure
[AGENT][NEUTRAL] Oops, sorry.
[AGENT][NEUTRAL] For outpatient benefits, the policy pays up to $2,225. Uh, I show she has the full amount available at this time. Is there anything else I can help you with?
[CUSTOMER][NEUTRAL] Is there a copy for a specialist office visit or how does this insurance work?
[AGENT][NEUTRAL] Oh, so this is for an office visit. OK, let me.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] OK, so it looks like the policy would not cover the uh physician office visit co-pay. However, if other treatment is rendered in the office, uh, it is subject to the $2,025 a calendar year.
[CUSTOMER][NEUTRAL] OK, so, um, you said the copay is not covered?
[AGENT][NEUTRAL] The offices the co-pay is not covered.
[CUSTOMER][NEUTRAL] OK, the office visit pay is not covered, OK, but if other treatment is.
[AGENT][NEUTRAL] Mhm. Uh, that is subject to the, yes. If patient responsibility is applied to the other treatment in the office while they're in the office, uh, that is paid up to $2,025 a calendar year.
[CUSTOMER][NEUTRAL] Done, yes.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] OK, and um the group number is it 262-61?
[AGENT][NEUTRAL] Let me get that for you.
[AGENT][NEUTRAL] Yes, it is.
[CUSTOMER][NEUTRAL] OK and let me see.
[CUSTOMER][NEUTRAL] And the claims, can they be sent electronically or does it have to be paper?
[AGENT][NEUTRAL] They can.
[AGENT][NEUTRAL] They can, and the, uh, payer ID for electronic claims is 60801.
[CUSTOMER][NEUTRAL] And what's the claims address?
[AGENT][NEUTRAL] Plain's mailing address is [PII].
[AGENT][NEUTRAL] [PII].
[CUSTOMER][NEUTRAL] OK
[CUSTOMER][POSITIVE] Thank you for your help.
[AGENT][POSITIVE] You're welcome, [PII]. You have a wonderful day and thank you for calling APL.
[CUSTOMER][POSITIVE] Thank you you too.
[AGENT][NEUTRAL] Bye bye.
[CUSTOMER][NEUTRAL] Bye.