AccountId: 011433970860
ContactId: f87b87d8-248c-4a62-b532-e044b1634dce
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 354100 ms
Total Talk Time (AGENT): 216653 ms
Total Talk Time (CUSTOMER): 152967 ms
Interruptions: 4
Overall Sentiment: AGENT=0.6, CUSTOMER=0.3
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/05/21/f87b87d8-248c-4a62-b532-e044b1634dce_20250521T14:30_UTC.wav
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[AGENT][NEUTRAL] Thank you for calling APL. This is [PII]. How can I help you?
[CUSTOMER][NEUTRAL] You
[CUSTOMER][NEUTRAL] Yes, [PII], my name is [PII]. I'm calling from [PII]. I'm trying to verify eligibility and benefits on a patient for an office visit, uh, primary care visit.
[AGENT][NEUTRAL] OK, I can check those uh eligibility and benefits and make sure that offices are covered under this policy uh [PII] can I get a good call back number from you first in case we're disconnected?
[CUSTOMER][NEUTRAL] [PII].
[CUSTOMER][NEUTRAL] 8
[CUSTOMER][NEUTRAL] I'm sorry, [PII] I'm sorry [PII]. I drew a blank all of a sudden.
[AGENT][NEUTRAL] That's OK.
[AGENT][NEUTRAL] That's OK. It happens.
[AGENT][NEUTRAL] It's still early right and then do you have that policy number?
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] It's 02491802.
[AGENT][NEUTRAL] OK and then what was the name and date of birth for the member please?
[CUSTOMER][NEUTRAL] I have [PII]. Date of birth [PII].
[AGENT][NEUTRAL] OK, thank you for verifying that. Uh, so this policy is active. Effective date was [PII], and this is a limited indemnity medical plan so it does pay a set dollar amount per covered procedure or office visit. If you'll give me one moment, I'll get that policy pulled up and see if office visits are covered under this policy.
[CUSTOMER][NEUTRAL] Uh-huh.
[CUSTOMER][POSITIVE] Thank you
[CUSTOMER][NEUTRAL] But
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] Was this regarding um a sickness or an injury or was this like a routine uh checkup wellness exam?
[CUSTOMER][NEUTRAL] Uh, let me see what it says for him. It looks like it's just a routine.
[AGENT][NEUTRAL] Mhm.
[AGENT][NEUTRAL] OK, in that case, um, I don't believe that would be covered under this policy. Typically these are part of a multi plan, um, I couldn't say for sure. I don't have all of the information, um, but I do know a lot of these members have separate policies through, um, 90 degree benefits or, uh, IMA, and those are typically where most of those wellness benefits are going to be. This policy is going to be more along the lines of um.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] sickness or injuries and hospital care and such. But let me see.
[CUSTOMER][NEUTRAL] OK. And if it was a sickness visit, what would be the coverage?
[AGENT][NEUTRAL] Go ahead, I'm sorry.
[AGENT][NEUTRAL] Give me just a moment because this one might have a wellness benefit um but let me just make sure give me just a moment.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] Alrighty, and of course I will let you know verification of coverage is not a guarantee of payment for claims. So this member does have the wellness and diagnostic benefit rider. um, wellness exam, uh, is going to be, it would pay up to $75 per visit, um, and then there's a separate, uh, well, you did say it was routine, so he does have a separate diagnostic testing benefit as well, um, but that doesn't sound like that's going to happen today.
[CUSTOMER][NEUTRAL] Uh-huh.
[CUSTOMER][NEUTRAL] I
[CUSTOMER][NEUTRAL] I'm sorry, your phone was breaking up. He doesn't have what?
[AGENT][POSITIVE] Oh, I'm sorry.
[AGENT][NEUTRAL] No, I'm sorry, um, I was gonna say he does have that, uh, diagnostic testing benefit as well. Um, if that were to happen that would pay an additional $250 for a diagnostic testing benefit. Wellness exam on its own is $75 that we would pay.
[CUSTOMER][NEUTRAL] OK, so this plan covers 250?
[AGENT][NEUTRAL] If it was a diagnostic test uh being performed, if it was just a wellness exam, it would be $75.
[CUSTOMER][NEUTRAL] OK, if it's not a wellness exam because I don't see where he's scheduled or scheduled as a wellness, it's just his office visit, so I'm assuming it would be like a sick visit.
[AGENT][NEUTRAL] Sure.
[AGENT][NEUTRAL] I see.
[AGENT][NEUTRAL] OK, if that's the case, he does have that benefit as well, um, which would also pay $75 per visit.
[CUSTOMER][NEUTRAL] OK, and there's no copay, it just covers only $75 right?
[AGENT][POSITIVE] That's correct, yes.
[CUSTOMER][NEUTRAL] OK, and where do we mail the claims to?
[AGENT][NEUTRAL] Uh, that is [PII].
[CUSTOMER][NEUTRAL] First name
[AGENT][NEUTRAL] 950.
[CUSTOMER][NEUTRAL] Yes.
[AGENT][NEUTRAL] And that is in [PII].
[CUSTOMER][NEUTRAL] I
[CUSTOMER][NEUTRAL] I'm sorry, so it's not the what's on the back of the card says [PII]. That's not it.
[AGENT][NEUTRAL] That would be a part of their multi plan as I said um that would be for claims uh.
[AGENT][NEUTRAL] With uh IMA.
[CUSTOMER][NEUTRAL] OK, I'm sorry, so it's it's post office box.
[AGENT][MIXED] This can be a bit confusing. No, no, you're perfectly fine.
[AGENT][NEUTRAL] Yes, [PII].
[CUSTOMER][NEUTRAL] Um,
[AGENT][NEUTRAL] 950.
[CUSTOMER][NEUTRAL] Mhm
[CUSTOMER][NEUTRAL] Uh-huh.
[AGENT][NEUTRAL] [PII].
[CUSTOMER][NEUTRAL] Did they give him a
[CUSTOMER][NEUTRAL] The appointment is on the [PII].
[AGENT][NEUTRAL] Zip code is [PII].
[CUSTOMER][NEUTRAL] And
[AGENT][NEUTRAL] [PII].
[CUSTOMER][NEUTRAL] It's
[CUSTOMER][NEUTRAL] Oops, your phone was breaking up again. [PII]. That's OK.
[AGENT][NEGATIVE] Oh sorry, oh no.
[AGENT][NEUTRAL] [PII].
[CUSTOMER][NEUTRAL] OK, I'm gonna repeat that. I have [PII].
[AGENT][NEUTRAL] Mhm.
[AGENT][POSITIVE] Correct.
[AGENT][NEUTRAL] And I've also got a uh fax number and a payer ID if you'd like.
[CUSTOMER][NEUTRAL] Yeah, yeah,
[CUSTOMER][NEUTRAL] The payer ID please.
[AGENT][NEUTRAL] Yes, that is 60801.
[CUSTOMER][POSITIVE] You love them, but.
[CUSTOMER][NEUTRAL] 60801 and you said this is multi plan?
[AGENT][NEUTRAL] Um, so that's a part of a multi plan. This is APL, American Public Life.
[CUSTOMER][NEUTRAL] I.
[CUSTOMER][POSITIVE] AP American Public Life, OK, alrighty, thank you very much, [PII].
[AGENT][NEUTRAL] Yes.
[AGENT][NEUTRAL] Sure, was there anything else I could help you with?
[CUSTOMER][NEUTRAL] Um, that's it.
[AGENT][POSITIVE] Alright well thanks for giving us a call [PII]. I hope you have a great rest of your day.
[CUSTOMER][NEUTRAL] You too bye bye.
[AGENT][POSITIVE] Thank you. Bye bye.