AccountId: 011433970860
ContactId: edd4acfc-e701-44ca-a387-4c7ab780281b
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 192850 ms
Total Talk Time (AGENT): 113717 ms
Total Talk Time (CUSTOMER): 51179 ms
Interruptions: 0
Overall Sentiment: AGENT=1, CUSTOMER=1.7
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/05/30/edd4acfc-e701-44ca-a387-4c7ab780281b_20250530T13:11_UTC.wav
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[AGENT][NEUTRAL] Thank you for calling APL. This is [PII]. How can I help you?
[CUSTOMER][POSITIVE] Good morning how are you?
[AGENT][POSITIVE] Good, how are you?
[CUSTOMER][POSITIVE] Good good um I am calling to get benefits and eligibility for a member please.
[AGENT][POSITIVE] All right, I'm happy to check benefits and eligibility. Can I get their policy number?
[CUSTOMER][NEUTRAL] Of course it's 025.
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] 43833.
[AGENT][POSITIVE] Thank you.
[AGENT][NEUTRAL] And then for documentation if I could get your first name and a callback number please.
[CUSTOMER][POSITIVE] You're welcome.
[CUSTOMER][NEUTRAL] Of course it's [PII].
[CUSTOMER][NEUTRAL] And it's [PII].
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] Thank you, [PII]. And then what is the patient name and date of birth?
[CUSTOMER][NEUTRAL] Yes, it's [PII] and it's [PII].
[AGENT][NEUTRAL] Thank you for that. So one is active. Effective date is [PII]. We are the members secondary insurance, so this covers deductible, co-pay, co-insurance, the primary does not.
[CUSTOMER][POSITIVE] So it covers, say it again I'm sorry. I'm so sorry.
[AGENT][NEUTRAL] No, that's OK. So it covers deductible, co-pay, and then co-insurance at the primary does not.
[CUSTOMER][NEUTRAL] So it uh over the primary it doesn't, but this is for a specialist it covers that.
[AGENT][NEUTRAL] Right, yes, it would. Um, is it for just like an office visit?
[CUSTOMER][NEUTRAL] It's an office visit and then a pro a procedure would be done as well.
[AGENT][NEUTRAL] OK, let me see if the plan covers any sort of office visits because sometimes the copay for the office visit is not included.
[AGENT][NEUTRAL] Um,
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] They do have an outpatient benefit max. Let me give you that. Um, it looks like on their plan, it's $500 per calendar day.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] And that of course is verification of benefits, not a guarantee of payment.
[AGENT][NEUTRAL] Um, let's see.
[AGENT][NEUTRAL] All right. So yeah, this patient's plan actually does cover physician's office visits. So, um, yeah, it's gonna cover any sort of co-pay, deductible, or co-insurance from the primary since we're the gap or the secondary. We're gonna pick that up.
[CUSTOMER][NEUTRAL] OK, OK.
[CUSTOMER][NEUTRAL] So the 500 covers office visit and procedures correct?
[AGENT][NEUTRAL] Yes, yes, ma'am. So, yeah, the $500 max is per day. It's not gonna pay over that.
[CUSTOMER][POSITIVE] OK, perfect. OK, that was fine if you could just provide me a reference for the call please.
[AGENT][NEUTRAL] Absolutely. That's my name with today's date. My name again is [PII], that's [PII] My last initial is gonna be [PII], and then today's date.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][POSITIVE] OK perfect thank you so much you have a good weekend OK?
[AGENT][NEUTRAL] You too. Bye-bye.