AccountId: 011433970860
ContactId: eea0efe5-585c-43e0-ad54-dc2b512b4137
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 502880 ms
Total Talk Time (AGENT): 141868 ms
Total Talk Time (CUSTOMER): 240321 ms
Interruptions: 0
Overall Sentiment: AGENT=0.7, CUSTOMER=0.7
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/04/09/eea0efe5-585c-43e0-ad54-dc2b512b4137_20250409T16:46_UTC.wav
--------------------------------------------
[AGENT][NEUTRAL] Thank you for calling APL. This is [PII]. How may I help you?
[CUSTOMER][NEUTRAL] Hi, [PII]. This is [PII] calling from Forever Care OBGYN clinic. And I'm calling right now to check if the um patients assurance is
[CUSTOMER][NEUTRAL] Um
[CUSTOMER][NEUTRAL] Active as of for today. Mhm.
[AGENT][NEUTRAL] OK.
[AGENT][POSITIVE] Yes ma'am, I can help you with eligibility, Miss [PII]. Can I please get your callback number just in case our call is disconnected?
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Yes, it's [PII].
[AGENT][NEUTRAL] Thank you ma'am, and then what is the patient's name, date of birth, and policy number?
[CUSTOMER][NEUTRAL] OK. Patient's name is [PII] and the date of birth is [PII]. The member ID number or the policy number is 02555554.
[AGENT][NEUTRAL] OK, let me look that up real quick.
[AGENT][NEUTRAL] OK, I do find [PII] does have an active policy and the effective date of this policy is [PII].
[CUSTOMER][NEUTRAL] OK. Wait. Um,
[AGENT][POSITIVE] You're welcome.
[CUSTOMER][NEUTRAL] Let me just
[CUSTOMER][POSITIVE] Yeah, thank you so much better. So is, is it still handled by IMA?
[AGENT][NEUTRAL] Yes ma'am.
[CUSTOMER][POSITIVE] OK, it's still effective as of today, right?
[AGENT][NEUTRAL] Yes, ma'am.
[CUSTOMER][POSITIVE] Effective.
[AGENT][NEUTRAL] It's been
[CUSTOMER][NEUTRAL] And um does it indicate there when will be the um end date?
[AGENT][NEUTRAL] No, ma'am, the policy is still active and current. The policy has been active since [PII].
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK, wait.
[CUSTOMER][NEUTRAL] Give me just a few moments, ma'am.
[AGENT][NEUTRAL] Yes, ma'am.
[CUSTOMER][NEUTRAL] [PII].
[CUSTOMER][NEUTRAL] No end date.
[CUSTOMER][NEUTRAL] OK. And um, is, uh, would you please verify if uh the benefit information for a specialist office visit is, um,
[CUSTOMER][NEUTRAL] Uh, the plan will pay $50 of the allowed amount. And, uh, since it's
[CUSTOMER][NEUTRAL] Indicated here based on uh the um conversation that I had with uh the representative when I called it says there is a maximum of visits per year. Can you please tell me how many.
[CUSTOMER][NEUTRAL] Visits are um allowed and the remaining for this year.
[AGENT][NEUTRAL] Yes, ma'am. OK, so, and this is just to verify benefits. It's not a guarantee of payment. The patient is allowed for office visits per calendar year for accident and sickness.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] Um, you're correct, it does pay $50. Let me see if anything's been used for the year of [PII].
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] It's gonna be just a second.
[AGENT][NEUTRAL] No office visits have been used for the year of [PII].
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK. No, uh, 0 out of 4. And can you please confirm as well, uh, the benefit information for procedure and ultrasound and if it's still not covered by this plan?
[AGENT][POSITIVE] Yes, ma'am, that is correct.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK, let me know that one first. Please bear with me. Can you please provide a rep and I'm sorry, I have to ask, I, I mean, I need to ask for your name and uh the reference number.
[AGENT][NEUTRAL] Yes, ma'am, um, the reference number will be my name [PII] and today's date.
[CUSTOMER][NEUTRAL] Yeah
[CUSTOMER][NEUTRAL] OK. Thank you so much, [PII]. Um, that's all for now. So this plan is still active. Uh, the effective date was [PII] and it's still active as current. And um for the, um, specialist office visit, plan will pay $50 of the allowed amount and then um procedure and ultrasounds are not covered by this plan.
[AGENT][NEUTRAL] OK. So, is an ultrasound considered a diagnostic test?
[CUSTOMER][NEUTRAL] Yes, it's a diagnostic imaging.
[AGENT][NEUTRAL] OK, so this policy does have diagnostic testing benefit.
[AGENT][NEUTRAL] Uh, that pays up to $100.
[CUSTOMER][NEUTRAL] Mm, OK.
[CUSTOMER][NEUTRAL] So plan will pay $100.
[AGENT][NEUTRAL] Yes, ma'am. Up to $100 for diagnostic testing. And, and then if um.
[CUSTOMER][NEUTRAL] And
[AGENT][NEUTRAL] After the first initial test, if a follow-up test needs to be done, then it'll cover, uh,
[AGENT][NEUTRAL] Let's see.
[AGENT][NEUTRAL] $25.
[AGENT][NEUTRAL] On a follow-up test.
[CUSTOMER][NEUTRAL] OK, so.
[CUSTOMER][NEUTRAL] So uh for follow-up, it's $25.
[AGENT][NEUTRAL] Yes.
[AGENT][NEUTRAL] And they get one per calendar year.
[CUSTOMER][NEUTRAL] $25.
[CUSTOMER][NEUTRAL] This is only 10.
[CUSTOMER][NEUTRAL] So this benefit is only one per, per policy year.
[AGENT][NEUTRAL] So
[AGENT][NEUTRAL] Right. So the diagnostic, the first initial diagnostic testing is one, and then a follow-up diagnostic test is also one.
[CUSTOMER][NEUTRAL] Oh, OK, one each.
[AGENT][NEUTRAL] Yes.
[CUSTOMER][NEUTRAL] One visit.
[CUSTOMER][NEUTRAL] For
[CUSTOMER][NEUTRAL] It's uh for each. So plan will pay $100 the allowed amount. And uh for follow-up diagnostic test, it's, it is a $25 copay and uh there is only one.
[AGENT][NEUTRAL] No.
[CUSTOMER][NEUTRAL] Mm, OK, sorry, please go ahead.
[AGENT][NEUTRAL] No, that $25 is not a co-pay, it's a benefit.
[CUSTOMER][NEUTRAL] Yeah, yeah, uh, there, I'm sorry. So this is how much the plan pay, right? $25.
[AGENT][POSITIVE] Right, correct.
[CUSTOMER][NEUTRAL] OK. Oh, I'm wrong with that one. Yeah, plan will pay $100 of the allowed amount for the initial visit. And uh for the follow-up, plan will pay $25 of the allowed amount. And there is a limit of one visit for each vis uh for each diagnostic, diagnostic visit.
[AGENT][NEUTRAL] Yes, ma'am.
[AGENT][NEUTRAL] Yes, ma'am.
[AGENT][POSITIVE] Yes, you've got it. Yes, ma'am, that's it.
[CUSTOMER][POSITIVE] OK. Thank you so much, [PII], for um helping me out today. Uh, this is all noted. Thank you so much and I hope that you'll have a great day. Goodbye for now.
[AGENT][NEUTRAL] No, no, OK, are you still there? I'm sorry, we just had a little hiccup in.