AccountId: 011433970860
ContactId: eed6b008-6a96-4067-93eb-343f0e3efb2f
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 181679 ms
Total Talk Time (AGENT): 91082 ms
Total Talk Time (CUSTOMER): 104218 ms
Interruptions: 2
Overall Sentiment: AGENT=1.1, CUSTOMER=0.4
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/04/14/eed6b008-6a96-4067-93eb-343f0e3efb2f_20250414T20:55_UTC.wav
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[AGENT][NEUTRAL] Thank you for calling APL. This is [PII]. How can I help you?
[CUSTOMER][NEUTRAL] Hi, I'm sorry, what did you say your name is [PII]?
[AGENT][NEUTRAL] Yes.
[CUSTOMER][NEUTRAL] [PII], hi [PII]. My name is [PII]. The first initial of my last name is [PII] Can I ask the first initial of your last name?
[AGENT][NEUTRAL] Sure, it's A
[CUSTOMER][NEUTRAL] Thank you. I'm calling from Doctor [PII]'s office to Vital and Group Holdings. We have a patient that's um, gonna have a procedure in our office, and she has a deductible, so we wanna know how much of the of the deductible do you cover for the in office procedure.
[AGENT][NEUTRAL] Mhm.
[AGENT][NEUTRAL] Sure.
[AGENT][NEUTRAL] Got you. OK, for treatment received in office, I will take a look at those benefits. Um, [PII], can I get a good call back number from you first in case we're disconnected?
[CUSTOMER][NEUTRAL] In office.
[CUSTOMER][NEUTRAL] like you
[CUSTOMER][NEUTRAL] Sure, sure, [PII]. Well, if we're, well, if we're disconnected, I'll have to call back tomorrow because the phone is now going on service, hopefully.
[AGENT][POSITIVE] Thank you.
[AGENT][POSITIVE] Oh no, OK, well, we'll hopefully we can get it soon. All right, did you have that?
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] Hopefully, exactly, well, sure, the policy number is um outpatient benefit 02506913ML8.
[AGENT][NEUTRAL] Did you have that policy number?
[AGENT][NEUTRAL] Got it and what was the first and last name uh for the member please?
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] OK, her name is [PII]. Last name is [PII]
[AGENT][NEUTRAL] OK, did you have her date of birth?
[CUSTOMER][NEUTRAL] Yeah, her date of birth is, hold on, let me get out of here, [PII].
[AGENT][NEUTRAL] Mhm.
[AGENT][NEUTRAL] Perfect, thank you for verifying that, [PII]. So of course this policy is active. Effective date was [PII], and as this is a secondary medical policy, it is designed to help with co-pay, deductible and co-insurance after major medical pays. And then of course I will let you know verification of coverage is not a guarantee of payment for claims. So this was a procedure she would be receiving in a physician's office setting, correct?
[CUSTOMER][NEUTRAL] Welcome.
[CUSTOMER][NEGATIVE] I no.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Yeah
[CUSTOMER][NEUTRAL] That's, that's correct, mhm, the code is 58558.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] OK, so for this policy office visits themselves are not covered. However, treatment received in office is so essentially if she was just being seen for, you know, a consultation that would not be covered, but any treatment received in office, that would fall under her outpatient benefit which is $2000 max per calendar year. If you'll give me one moment I'll see if any of that has been used.
[CUSTOMER][POSITIVE] OK, good.
[CUSTOMER][NEUTRAL] Yeah, OK.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK
[AGENT][NEUTRAL] OK, none has been used so far this year.
[CUSTOMER][POSITIVE] OK perfect none used.
[CUSTOMER][NEUTRAL] OK, so do I have a call reference number?
[AGENT][NEUTRAL] Sure, that would just be my first name, last initial and today's date. Was there anything else I could help you with, [PII]?
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][POSITIVE] No, that's it thank you so much have a great day bye bye.
[AGENT][POSITIVE] Alright, yeah, thanks for calling APL you too bye bye.
[CUSTOMER][NEUTRAL] Bye.