AccountId: 011433970860
ContactId: ef5db1da-d1ce-4790-ba8e-41e4d6abb6f9
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 402269 ms
Total Talk Time (AGENT): 241180 ms
Total Talk Time (CUSTOMER): 120348 ms
Interruptions: 4
Overall Sentiment: AGENT=1, CUSTOMER=0.3
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/01/16/ef5db1da-d1ce-4790-ba8e-41e4d6abb6f9_20250116T13:56_UTC.wav
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[AGENT][NEUTRAL] Good morning. Thank you for calling APL. This is [PII] speaking. How can I help you?
[CUSTOMER][NEUTRAL] Yes ma'am, I'm calling from a provider's office. I just need to verify eligibility on a patient.
[AGENT][POSITIVE] Certainly I can help you with eligibility. Can I have your first name please?
[CUSTOMER][NEUTRAL] [PII]
[AGENT][NEUTRAL] Thank you [PII] and what's the name of the provider you're calling from today?
[CUSTOMER][NEUTRAL] It's ankle and Foot Associates and it's Doctor [PII].
[AGENT][POSITIVE] And a good call back number in case we get disconnected?
[CUSTOMER][NEUTRAL] [PII].
[CUSTOMER][NEUTRAL] My extension is [PII].
[AGENT][NEUTRAL] Thank you [PII] and what's the policy certificate or member ID please?
[CUSTOMER][NEUTRAL] that
[CUSTOMER][NEUTRAL] It is 02469142.
[AGENT][POSITIVE] Thank you.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] And did you need to obtain benefits as well and also you just name the eligibility today.
[CUSTOMER][NEUTRAL] Um, probably benefits. I have one, I, I know one CPT code I need to go ahead and check.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] And that was gonna be my next question, so go ahead and verify patient's name and date of birth please.
[CUSTOMER][NEUTRAL] It is [PII] Date of birth is [PII].
[AGENT][POSITIVE] OK, thank you.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] Just to let you know this is a verification of coverage only, not a guarantee of payment. I show this policy is active.
[AGENT][NEUTRAL] Uh, their effective date for [PII].
[AGENT][NEUTRAL] And just give me one moment to pull up those benefits. Now this policy is a limited medical hospital indemnity plan.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] So it does have limited medical benefits.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] And what type of service are you needing uh benefits for today? Is that inpatient outpatient?
[CUSTOMER][NEUTRAL] Uh,
[CUSTOMER][NEUTRAL] Inpatient for podiatry.
[AGENT][NEUTRAL] And it's inpatient, OK.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] Just one moment please.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] And is this gonna be like a surgical procedure or is it diagnostic?
[CUSTOMER][NEUTRAL] Uh, right now it's just diagnostic.
[AGENT][NEUTRAL] OK, so they.
[CUSTOMER][NEUTRAL] It's, it's just go ahead.
[AGENT][NEUTRAL] They, they again this is a limited medical hospital indemnity, so they do have inpatient benefits under this plan.
[AGENT][NEUTRAL] Um, they have an inpatient admission benefit that's payable for $500 per day, and they're allowed one day per covered person per calendar year.
[AGENT][NEUTRAL] There's a confinement benefit that's payable at $800 per day with a max of 30 days per calendar year per covered person.
[AGENT][NEUTRAL] Um, and then they have, uh.
[CUSTOMER][NEUTRAL] And they have
[AGENT][NEUTRAL] A surgical benefit um under this plan as well as outpatient, uh, sickness and treatment.
[CUSTOMER][POSITIVE] This plan as well as foundation.
[CUSTOMER][NEUTRAL] The
[AGENT][NEUTRAL] And then the diagnostic that they have would be limited to certain medical imaging tests that are covered under the plan and that would be such as a CT scan, MRI um.
[CUSTOMER][NEUTRAL] And then the diagnostics that they have with.
[CUSTOMER][NEUTRAL] I
[CUSTOMER][NEUTRAL] That are covered under the plan
[CUSTOMER][NEUTRAL] And that would be such as a CT scan, MRI.
[AGENT][NEUTRAL] Uh, and then there's a couple of other services that are covered under there.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] So does this plan, does this plan cover a specialist office visit?
[AGENT][NEUTRAL] Go ahead.
[AGENT][NEUTRAL] There's an office visit, uh, that's allowed payable for a physician's office, and that would be for accident or sickness treatment. It's a $75 per day.
[CUSTOMER][NEUTRAL] There's an
[CUSTOMER][NEUTRAL] the North.
[CUSTOMER][NEUTRAL] It's a $75.
[AGENT][NEUTRAL] Uh, maximum for that office visit and they're allowed 6 office visits per person per calendar year.
[CUSTOMER][NEUTRAL] OK, only 6 office visits.
[AGENT][POSITIVE] That's correct, 6 days.
[CUSTOMER][NEUTRAL] Is there a deductible or out of pocket?
[AGENT][NEUTRAL] There is no deductible or out of pocket under this plan. It is limited medical hospital indemnity, so it doesn't work like a major medical. They don't have a co-insurance and or deductible. Those benefits are payable as a straight benefit payment such as the office visit again would be a 50 $75 maximum, you know, for, for that office visit itself. That's the benefit that we would pay for that service.
[CUSTOMER][NEUTRAL] OK
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] OK, are you able to um fax me a copy of the eligibility?
[AGENT][NEUTRAL] Um, I don't have a schedule that I can fax to you, um, not like a, uh.
[AGENT][NEUTRAL] Um,
[CUSTOMER][NEUTRAL] Like an EOB or anything?
[AGENT][NEUTRAL] Right under this plan, right? I don't have any, uh, schedule that I could fax to you unfortunately, um.
[CUSTOMER][NEUTRAL] OK
[CUSTOMER][NEUTRAL] OK, that's fine. Well then that's all I needed for today then.
[AGENT][NEUTRAL] There's no, yeah, there's no laboratory, um, that is the outpatient benefit that's allowed under the plan, um, and again they do have other benefits under this plan such as like, like I said, the uh surgery and uh diagnostic testing.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Oh yeah I'm.
[CUSTOMER][NEUTRAL] Yeah, could you check check one CPT code for me?
[AGENT][NEUTRAL] Um, sure, what is that CPT code?
[CUSTOMER][NEUTRAL] It's 3000.
[AGENT][NEUTRAL] And is that like a DME?
[CUSTOMER][NEUTRAL] Yes
[AGENT][NEUTRAL] OK, yeah, there is no DME covered under this plan like I said, it's, it's, it is uh.
[AGENT][NEUTRAL] It's a limited um coverage. So like I said, there's no outpatient laboratory, um there's no DME allowed under this plan. Um, it is not a major medical again, it's, it doesn't need that, uh, comprehensive, right, yeah, because it's indemnity.
[CUSTOMER][NEUTRAL] It's indemnity, OK.
[CUSTOMER][NEUTRAL] OK, so there's no DME coverage and no outpatient lab work either.
[AGENT][POSITIVE] That's correct.
[CUSTOMER][POSITIVE] OK, alrighty, I appreciate your time today.
[AGENT][NEUTRAL] You're welcome [PII]. Did you have any other questions?
[CUSTOMER][NEUTRAL] Alright.
[CUSTOMER][NEUTRAL] No, I do not. That is all.
[AGENT][NEUTRAL] OK, and if you need a reference number, you would use my name in today's date, first name [PII] Last initial is L like love.
[CUSTOMER][POSITIVE] OK all right thank you so much [PII].
[AGENT][POSITIVE] You're welcome, [PII] thank you for calling AP. I hope you have a great rest of your day.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] You too bye bye.
[AGENT][POSITIVE] Thank you bye bye.