AccountId: 011433970860
ContactId: efce9bd0-5aa5-4d36-9a00-68ed50457b62
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 235910 ms
Total Talk Time (AGENT): 101815 ms
Total Talk Time (CUSTOMER): 88066 ms
Interruptions: 0
Overall Sentiment: AGENT=1, CUSTOMER=0.5
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/03/05/efce9bd0-5aa5-4d36-9a00-68ed50457b62_20250305T21:00_UTC.wav
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[AGENT][NEUTRAL] Thank you for calling American Public Life. This is [PII]. How may I assist you?
[CUSTOMER][POSITIVE] Uh, yes ma'am. I'm trying to get eligibility and benefits for a patient that's coming to our office.
[AGENT][NEUTRAL] May I have your name and a callback number?
[CUSTOMER][NEUTRAL] Sure, it's uh [PII], and our callback number is [PII]. I'm also needing to know if we have any type of, uh, if we're in or out of network with y'all. This is the first time I'm seeing this insurance.
[AGENT][NEUTRAL] OK, may I please have the policy number?
[CUSTOMER][NEUTRAL] Um, the policy number that I have is going to be 025062669.
[AGENT][POSITIVE] Thank you.
[CUSTOMER][NEUTRAL] So
[AGENT][NEUTRAL] May I have the patient's name and date of birth?
[CUSTOMER][NEUTRAL] I have Chau, uh, date of birth is [PII].
[AGENT][NEUTRAL] And you're calling in for eligibility and benefits, is there a specific benefit that you're calling in for?
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Uh, a specialist office visit, we are a dermatology office, so.
[AGENT][NEUTRAL] OK.
[CUSTOMER][POSITIVE] And they're gonna be a new patient to us.
[AGENT][NEUTRAL] OK, I'm pulling that information up for you now.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] And this policy is their supplemental to their primary.
[AGENT][NEUTRAL] And it does show that the policy is currently active. The effective date is [PII]. So with this policy being the supplemental, it's not considered a major medical, so it's not based off of in or out of network.
[CUSTOMER][NEUTRAL] Yeah, OK.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Um.
[AGENT][POSITIVE] And I'm pulling those benefits up for you.
[CUSTOMER][NEUTRAL] OK
[AGENT][NEUTRAL] And verification of coverage does not guarantee the payment of the claim for this policy, the member does have up to $7500 per calendar year. That would just go towards the member's deductible, coinsurance, or co-pay for the primary for the office procedure. This policy does not cover the office visit fee.
[CUSTOMER][NEUTRAL] No
[CUSTOMER][NEUTRAL] I
[CUSTOMER][NEUTRAL] OK, so you'll pay up to 7500 for any type of procedure as a supplemental that's going to the patient's deductible?
[AGENT][NEUTRAL] Deductible coinsurance, or co-pay for the procedure.
[CUSTOMER][NEUTRAL] OK
[CUSTOMER][NEUTRAL] But there's no um.
[CUSTOMER][NEUTRAL] There's no office benefit, just procedures.
[AGENT][NEUTRAL] Correct, we do not cover the office visit fee.
[CUSTOMER][NEUTRAL] Alrighty, um, if I can go ahead and, uh, can you tell me if they've met any of the 7500?
[AGENT][NEUTRAL] Let me see if they've used any of their benefits.
[AGENT][NEGATIVE] As of right now, the member has not used any of their benefits.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Is there any type of reference number?
[AGENT][NEUTRAL] The reference will be my first name [PII], last initial of [PII] and today's date. And also let me advise you that this policy is only for sickness and injury. It will not cover any preventative or wellness.
[CUSTOMER][NEUTRAL] OK
[CUSTOMER][NEUTRAL] Or injury.
[CUSTOMER][NEUTRAL] Um
[CUSTOMER][NEUTRAL] [PII], can you spell your first name for me just to make sure I did it correctly.
[AGENT][NEUTRAL] Yes, it is spelled [PII]
[CUSTOMER][POSITIVE] Thank you so much I appreciate your time this afternoon.
[AGENT][POSITIVE] You're welcome. Thank you so much for calling American Public Life. You have a great rest of your day.
[CUSTOMER][NEUTRAL] You too bye bye.
[AGENT][POSITIVE] Thank you.