AccountId: 011433970860
ContactId: f748c686-43d6-4304-954e-c0e998904c27
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 296850 ms
Total Talk Time (AGENT): 123500 ms
Total Talk Time (CUSTOMER): 102825 ms
Interruptions: 1
Overall Sentiment: AGENT=1.5, CUSTOMER=0.9
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/05/21/f748c686-43d6-4304-954e-c0e998904c27_20250521T14:56_UTC.wav
--------------------------------------------
[AGENT][POSITIVE] Good morning. Thank you for calling APL. My name is [PII]. How may I help you?
[CUSTOMER][NEUTRAL] Hi, I wanna check a little busy on a patient.
[AGENT][POSITIVE] OK, I can definitely help you with the eligibility. May I have your name and a good contact number in case we're disconnected?
[CUSTOMER][NEUTRAL] Yes, my name is [PII]
[CUSTOMER][NEUTRAL] And the callback number is [PII].
[AGENT][NEUTRAL] Thank you. May I have the member's policy number?
[CUSTOMER][NEUTRAL] Yes it is.
[CUSTOMER][NEUTRAL] One second, let me get his information.
[AGENT][POSITIVE] Mhm take your time.
[CUSTOMER][NEUTRAL] It's 026.
[CUSTOMER][NEUTRAL] 16A27 ML 8.
[AGENT][NEUTRAL] Thank you, hold on one moment.
[AGENT][NEUTRAL] And can you verify the member's first and last name and date of birth?
[CUSTOMER][NEUTRAL] Yes, the name is. The last name is [PII] and the date of birth is [PII].
[AGENT][NEUTRAL] Thank you for that and all the information provided is a verification of benefits, not a guarantee of payment. And I am showing the policy is active. It's been effective since [PII].
[CUSTOMER][NEUTRAL] OK, um, it is a secondary insurance, so does it cover any co-pays?
[AGENT][NEUTRAL] Um, so our policy pays towards the copay, deductible and co-insurance of covered charges after primary. Are you all considered outpatient?
[CUSTOMER][NEUTRAL] Yeah, give me one second.
[CUSTOMER][POSITIVE] Hi, good uh good morning.
[AGENT][NEUTRAL] Hi, how are you?
[CUSTOMER][POSITIVE] Good, good, yes, I'm, um, we're calling for patients benefits and eligibility please.
[AGENT][NEUTRAL] Right, I was asking if you all are considered outpatient or inpatient?
[CUSTOMER][NEUTRAL] Outpatient, yeah, no, um, is our office.
[AGENT][NEUTRAL] So the benefit is
[AGENT][NEUTRAL] Up to $1000 per calendar year. Um, did you want me to see if any has been used for this year?
[CUSTOMER][NEUTRAL] Please, yes.
[AGENT][NEUTRAL] OK, hold on one moment.
[AGENT][NEUTRAL] And none of the benefits have been used for [PII], so he says that 4000 for the year.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] And for the secondary does it cover like um.
[CUSTOMER][NEUTRAL] Co-pay or deductibles or just procedure wise?
[AGENT][NEUTRAL] So, wait, so is this someone else because we just went over, so we pay towards the copay, deductible and co-insurance of coverage charges after primary up to that $1000 per calendar year.
[CUSTOMER][NEUTRAL] Yeah
[CUSTOMER][NEUTRAL] OK, so yeah, it's a different person because she was, she just, she's new, so I'm just helping her, um, um, so for specialist does that also apply or just in general office visit it helps $1000 for the for everything.
[AGENT][NEUTRAL] Mhm.
[AGENT][NEUTRAL] Let me see if they have hold on one moment.
[AGENT][NEUTRAL] Just waiting for the benefits to populate. Hold on one moment.
[CUSTOMER][NEUTRAL] I don't
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] So this policy doesn't have the office treatment rider, so anything in the like in the office setting wouldn't be covered by this policy. Um, it would just be like the outpatient facility, um, urgent care, outpatient surgeries, but I'm going to just double check just to make sure.
[AGENT][NEUTRAL] On their big policy. Hold on one moment.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] Yes, so this policy doesn't have any coverage for the office setting. Um, it would just be like the emergency room, urgent care, outpatient surgeries, um, diagnostic testing in outpatient facilities.
[CUSTOMER][NEUTRAL] Got it.
[CUSTOMER][NEUTRAL] OK, OK, so, so then I'll just cover like other types of visits, but for office settings, the second day won't cover.
[AGENT][POSITIVE] Correct.
[CUSTOMER][POSITIVE] OK, OK, perfect, um, thank you so much for your help. um, may I have your name please and a reference number?
[AGENT][POSITIVE] You're welcome.
[AGENT][NEUTRAL] Sure, so there's no call reference number, but, but you can use my name in today's date. Again, my name is [PII], first initial to my last name is [PII], and then today's date.
[CUSTOMER][NEUTRAL] For my notes? Oh.
[CUSTOMER][POSITIVE] Perfect. OK, thank you so much, [PII]. You have a great week.
[AGENT][POSITIVE] You're welcome. Thanks for calling APL. Bye-bye.
[CUSTOMER][NEUTRAL] Bye.