AccountId: 011433970860
ContactId: ef0d4e70-94f5-4c7c-a5d5-8c19aa1d3c2e
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 270140 ms
Total Talk Time (AGENT): 128505 ms
Total Talk Time (CUSTOMER): 128000 ms
Interruptions: 1
Overall Sentiment: AGENT=1.3, CUSTOMER=0.4
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/03/27/ef0d4e70-94f5-4c7c-a5d5-8c19aa1d3c2e_20250327T13:15_UTC.wav
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[AGENT][NEUTRAL] Good morning. Thank you for calling APL. This is [PII]. How may I assist you?
[CUSTOMER][NEUTRAL] Yeah
[CUSTOMER][NEUTRAL] Yes, I was calling to check eligibility and benefits.
[AGENT][POSITIVE] OK, sure. I can assist you with eligibility and benefits. May I have your name?
[CUSTOMER][NEUTRAL] Yes, this is [PII]. Last initial is [PII].
[AGENT][NEUTRAL] OK. And may I have a callback number just in case we get disconnected and the name of the facility you're calling from from my notation.
[CUSTOMER][NEUTRAL] And now I look up the.
[CUSTOMER][NEUTRAL] Uh
[CUSTOMER][NEUTRAL] Alright, uh, number is [PII], and then I'm calling from Family allergy and asthma.
[AGENT][NEUTRAL] Mhm.
[AGENT][NEUTRAL] OK. Thank you. All right. And Miss [PII], may I have the patient's policy number?
[CUSTOMER][NEUTRAL] I have 022129557 M as in Mary, L as in Larry and the number 8.
[AGENT][POSITIVE] Thank you.
[AGENT][NEUTRAL] May I have the name and date of birth of the patient?
[CUSTOMER][NEUTRAL] Those leaders were.
[CUSTOMER][NEUTRAL] [PII] and date of birth is [PII].
[AGENT][NEUTRAL] OK, um, I think I got a number too much. Can you repeat that number, the policy number one more time?
[CUSTOMER][NEUTRAL] Yeah
[CUSTOMER][NEUTRAL] Yes, 02212957 M as in Mary, L as in Larry, then it has an 8 at the end.
[AGENT][NEUTRAL] Got you. OK, thank you. I have you guys. All right. Thank you. And you said you need eligibility today. Um, we have an effective date of [PII]. It is active at the moment and this is one of our secondary supplemental plans for the major medical.
[CUSTOMER][NEUTRAL] that
[CUSTOMER][NEUTRAL] Mhm
[CUSTOMER][NEUTRAL] Yes.
[CUSTOMER][NEUTRAL] Look at the
[AGENT][NEUTRAL] And let me see if it covers anything in office.
[CUSTOMER][NEUTRAL] It's
[AGENT][NEUTRAL] OK, bear with me.
[CUSTOMER][NEUTRAL] OK
[CUSTOMER][NEUTRAL] How
[CUSTOMER][NEUTRAL] She can build that the guy that build.
[AGENT][NEUTRAL] OK. So this one, and this is not a guarantee of payment, just a verification of coverage and that's just a disclaimer. This one covers office procedures or office treatment. It does not cover the office visit co-payment.
[CUSTOMER][NEUTRAL] You.
[CUSTOMER][NEUTRAL] that was all.
[AGENT][NEUTRAL] But it will only cover the treatments or procedures done in an office, and that is an outpatient maximum of $500 daily.
[CUSTOMER][NEUTRAL] But
[CUSTOMER][NEUTRAL] OK, so just to repeat that, it doesn't cover uh specialty office visits copay, right?
[AGENT][POSITIVE] Correct.
[CUSTOMER][MIXED] OK, and it only covers the service.
[AGENT][NEUTRAL] It will only cover if there's.
[AGENT][NEUTRAL] Yeah, procedures done in the office or treatment done in the office. Mhm.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] And uh let me ask you, since this is secondary, do y'all pick up any deductibles or co-insurance from the primary?
[AGENT][NEUTRAL] Mm
[AGENT][NEUTRAL] We do. We, we cover the deductibles, co-payment and co-insurance from the major medical. The only thing, the only co-pay we do not cover is the one for the office visit itself, but other than that, yes.
[CUSTOMER][NEUTRAL] OK, and you was gonna give me an amount what was that for?
[AGENT][NEUTRAL] That is the daily benefit amount. Uh, there is a daily benefit amount that we cover, and that is $500 per day.
[CUSTOMER][NEUTRAL] OK, uh, daily benefit amount is $500 per day.
[AGENT][POSITIVE] Correct.
[CUSTOMER][NEUTRAL] OK, and then the rest will be the patient's responsibility?
[AGENT][NEUTRAL] If it's more than $500 a day, yes. Mhm.
[CUSTOMER][NEUTRAL] OK, hopefully not, but if so.
[AGENT][NEUTRAL] Mm
[CUSTOMER][NEUTRAL] Alrighty, and may I please have a call reference number?
[AGENT][NEUTRAL] Yes.
[AGENT][NEUTRAL] We don't have reference numbers. You can use my name in today's date if you will.
[CUSTOMER][NEUTRAL] OK, uh, can I have your name again?
[AGENT][NEUTRAL] Sure. My name is [PII].
[CUSTOMER][POSITIVE] All right perfect thank you so much you have a wonderful day.
[AGENT][POSITIVE] You are so, Ms. [PII], and thank you for calling APO. Have a good day.
[CUSTOMER][POSITIVE] Thank you bye bye.
[AGENT][POSITIVE] You're welcome. Bye bye.
[CUSTOMER][NEUTRAL] So