AccountId: 011433970860
ContactId: f45bf4f9-5afb-4ff5-a084-d26d7fa96c9c
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 210860 ms
Total Talk Time (AGENT): 112164 ms
Total Talk Time (CUSTOMER): 89493 ms
Interruptions: 3
Overall Sentiment: AGENT=1.2, CUSTOMER=0.5
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/04/14/f45bf4f9-5afb-4ff5-a084-d26d7fa96c9c_20250414T15:58_UTC.wav
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[AGENT][NEUTRAL] Thank you for calling APL. This is [PII]. How can I help you?
[CUSTOMER][NEUTRAL] Hi, good morning. I'm calling from a provider's office to check eligibility benefits on a member.
[AGENT][NEUTRAL] Sure, I could check eligibility and benefits for you. Uh, what was your name?
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] OK [PII], can I get a good call back number from you in case we disconnected?
[CUSTOMER][NEUTRAL] Sure, [PII].
[AGENT][NEUTRAL] Thank you. And then, uh, did you have that policy number?
[CUSTOMER][NEUTRAL] Yes, um, it is 023-08260.
[AGENT][NEUTRAL] OK and then what was the name and date of birth for the member please?
[CUSTOMER][NEUTRAL] The name is [PII]. Date of birth [PII].
[AGENT][NEUTRAL] Perfect, thank you for verifying that [PII]. Uh, so this policy is active. Effective date was [PII].
[AGENT][NEUTRAL] And this is a secondary medical policy, so it is designed to help with co-pay, deductible and co-insurance after major medical pays, and we're really need to look at, uh, inpatient or outpatient benefits.
[CUSTOMER][NEUTRAL] Mm
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] So, um I just want to know if there's do the benefits apply for office visits?
[AGENT][NEUTRAL] OK, let me see if office visits are covered.
[CUSTOMER][NEUTRAL] Yeah
[AGENT][NEUTRAL] Alrighty, and of course I will let you know verification of coverage is not a guarantee of payment for claims. So under this policy, office visits themselves are not covered. However, treatment received in office is.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] So if it was simply like a consultation, um, that would not be covered but if they were to receive any sort of treatment.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Um,
[CUSTOMER][NEUTRAL] OK, so for no for consultation, for yes for treatment, for co-payments.
[AGENT][POSITIVE] Correct.
[AGENT][POSITIVE] Correct, for an office visit, yes.
[AGENT][NEUTRAL] Or in in a physician's office environment.
[CUSTOMER][NEUTRAL] Um, treatments.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Um, now you say treatments. What, what exactly, because usually it's either you can.
[AGENT][NEUTRAL] Any sort of treatment like an X-ray or anything like that. Um, if it's something besides, you know,
[CUSTOMER][NEUTRAL] Sir, for an ultrasound, sir, for an ultrasound, it is covered.
[AGENT][POSITIVE] Yeah, that would absolutely, absolutely be covered. That's what that's that treatment.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] Essentially if it's not just any sort of consultation or talking, right.
[CUSTOMER][NEUTRAL] But just for a regular office visit.
[AGENT][NEUTRAL] If no treatment is received, I guess that's.
[CUSTOMER][NEUTRAL] OK. Uh.
[CUSTOMER][POSITIVE] I just sound gourmet. OK, perfect. And what is the maximum coverage?
[AGENT][NEUTRAL] Yeah, so that it's on a calendar year basis. Outpatient is $4000 max per calendar year. If you'll give me one moment, I'll see if, uh, any of that has been used.
[CUSTOMER][NEUTRAL] Mm.
[CUSTOMER][POSITIVE] OK, thank you.
[AGENT][NEUTRAL] Of course.
[AGENT][NEUTRAL] OK, so she has not used any of that so far this year.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] And that's for outpatient. OK, perfect. May I have a reference number for this call?
[AGENT][POSITIVE] Correct.
[AGENT][NEUTRAL] Reference number would just be my first name, last initial, and today's date. Uh, so my name is spelled [PII] And was there anything else I could help you with, [PII]?
[CUSTOMER][NEUTRAL] What is
[CUSTOMER][NEUTRAL] Yeah
[CUSTOMER][POSITIVE] No, that will be all. Thank you so much. Have a nice day.
[AGENT][NEUTRAL] All right.
[AGENT][POSITIVE] Yeah, thanks for calling APL you too bye bye.
[CUSTOMER][NEUTRAL] OK