AccountId: 011433970860
ContactId: e933358b-138a-4d3d-b294-1a6e2d3c2b76
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 223399 ms
Total Talk Time (AGENT): 90673 ms
Total Talk Time (CUSTOMER): 75259 ms
Interruptions: 0
Overall Sentiment: AGENT=1.8, CUSTOMER=1.1
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/01/21/e933358b-138a-4d3d-b294-1a6e2d3c2b76_20250121T20:12_UTC.wav
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[AGENT][POSITIVE] Good afternoon. Thank you for calling APL. My name is [PII]. How may I help you?
[CUSTOMER][NEUTRAL] Yeah
[CUSTOMER][NEUTRAL] Hi, good afternoon, [PII]. My name is [PII]. I am calling from the provider's office calling to get benefits on one of my patients.
[AGENT][POSITIVE] OK, well, I'll be more than happy to assist you with the benefits and, may I have a good contact number in case we're disconnected and the policy number?
[CUSTOMER][NEUTRAL] Yes. Uh phone number is [PII].
[CUSTOMER][NEUTRAL] [PII]
[CUSTOMER][NEUTRAL] [PII].
[CUSTOMER][NEUTRAL] And the policy number that I have here on file is 02.
[CUSTOMER][NEUTRAL] 44
[CUSTOMER][NEUTRAL] 3374.
[AGENT][NEUTRAL] Thank you, hold on one moment.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] And can you verify the member's first and last name and date of birth?
[CUSTOMER][NEUTRAL] Yes. First name is [PII]. Last name is [PII]. It's [PII], and date of birth is [PII].
[AGENT][NEUTRAL] Thank you for that and all the information provided is a verification of benefits, not a guarantee of payment. So I am showing the policy is active, it's been effective since [PII]. And um you said outpatient benefits?
[CUSTOMER][NEUTRAL] Uh, for an office specialist visit.
[AGENT][NEUTRAL] Office specialist visit? OK, hold on one moment.
[AGENT][NEUTRAL] OK, so the outpatient max per person is $1000 per calendar year.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] 4
[AGENT][NEUTRAL] And that does include um treatment in the physician or specialist office, um, diagnostic testing.
[AGENT][POSITIVE] Um, and I believe it has a surgery benefit as well.
[CUSTOMER][NEUTRAL] He conference to me.
[CUSTOMER][NEUTRAL] Me too.
[AGENT][NEUTRAL] Yes. Um, so they do have in office coverage up to the $1000 per calendar year.
[CUSTOMER][NEUTRAL] So yeah.
[CUSTOMER][NEUTRAL] OK. So, um, this secondary insurance covers up to $1000?
[AGENT][NEUTRAL] Right, up to $1000 per calendar year.
[AGENT][NEUTRAL] And there is a um deductible.
[AGENT][NEUTRAL] Of $1500.
[AGENT][NEUTRAL] Per calendar year. That hasn't been met yet.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] All right. And does it cover any deductible or out of pocket of the primary insurance?
[AGENT][NEUTRAL] Yes, we do pay towards the copay, deductible and co-insurance after the deductible um has been met for their secondary policy as well.
[CUSTOMER][NEUTRAL] And.
[CUSTOMER][NEUTRAL] Got it.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][POSITIVE] All right, perfect. I think that's all the information that I need. Is there a reference number to this call?
[AGENT][NEUTRAL] So there's no call reference number, but you can use my name in today's date. The first initial to my last name is [PII].
[CUSTOMER][POSITIVE] All right, perfect. Thank you so much for your help, and I hope you have a great day.
[AGENT][POSITIVE] You're very welcome. Was there anything else I could assist you with today?
[CUSTOMER][POSITIVE] No, that's gonna be all. Thank you so much. Have a great day.
[AGENT][POSITIVE] Alright [PII], you're welcome. Thanks for calling APL bye bye.