AccountId: 011433970860
ContactId: f9041b8e-c78f-4d22-9417-cc42eb6ff55d
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 235199 ms
Total Talk Time (AGENT): 136367 ms
Total Talk Time (CUSTOMER): 118824 ms
Interruptions: 3
Overall Sentiment: AGENT=1, CUSTOMER=0.5
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/02/21/f9041b8e-c78f-4d22-9417-cc42eb6ff55d_20250221T18:49_UTC.wav
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[CUSTOMER][NEUTRAL] Hi taonga to no dem more OK that you this see imma the key is the immada mean but city.
[AGENT][NEUTRAL] Hi, thank you for calling APL. This is [PII]. How can I help you?
[CUSTOMER][NEUTRAL] Hi, uh, you said [PII].
[AGENT][NEUTRAL] Yes, [PII]
[CUSTOMER][NEUTRAL] Hi [PII], this is [PII]. I'm calling you from [PII] ENT. I needed to verify on benefits for a member.
[AGENT][NEUTRAL] Sure I could check benefits for you uh you said your name was [PII]?
[CUSTOMER][NEUTRAL] [PII].
[AGENT][POSITIVE] Got you. And then can I get a good call back number from you in case we're disconnected?
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] Uh-huh.
[CUSTOMER][NEUTRAL] OK
[AGENT][NEUTRAL] Thank you. And then do you have the policy number?
[CUSTOMER][NEUTRAL] Uh yes, it's gonna be 01976373 M as in Mary L8.
[AGENT][NEUTRAL] OK, thank you and uh what was the name and date of birth for the patient?
[CUSTOMER][NEUTRAL] Yeah
[CUSTOMER][NEUTRAL] It is [PII] [PII].
[AGENT][NEUTRAL] Perfect, thank you for verifying that. Uh, so the policy is active. Effective date was [PII], 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 we needing to look at the outpatient benefits?
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Well, I wanted to see if it covers you said it covers copays and deductible?
[AGENT][NEUTRAL] Yes, um, so it is.
[CUSTOMER][NEUTRAL] And um sorry.
[AGENT][NEUTRAL] Go ahead sorry.
[CUSTOMER][NEUTRAL] No, go ahead, go ahead.
[AGENT][NEUTRAL] So yes, this policy is secondary. It is very dependent on their major medical, so it's designed to help with co-pay, deductible and co-insurance only after major medical pays. So it can't be used instead of major medical, if that makes sense.
[CUSTOMER][NEUTRAL] OK
[CUSTOMER][NEUTRAL] Right, so they're coming in for the visit, um, they're responsible for their own copay.
[AGENT][NEUTRAL] This is designed to help with it, um, with the co-pay, deductible and co-insurance. Is their major medical going to be contributing?
[CUSTOMER][NEUTRAL] Yes.
[AGENT][NEUTRAL] OK, and yeah that's uh all we would need for the clients are going to be the EOB uh showing that information.
[CUSTOMER][NEUTRAL] Oh, he called me.
[CUSTOMER][NEUTRAL] Oh, OK, so that that is something that they would fax over after and for any office procedures and anything like that that is covered?
[AGENT][NEUTRAL] Yeah.
[AGENT][NEUTRAL] Let's see, is this just for a regular uh physician's office?
[CUSTOMER][NEUTRAL] And
[CUSTOMER][NEUTRAL] Yes, but in case you do any like um ear wax removal or anything like that.
[AGENT][NEUTRAL] Treatment, sure, yeah, um, of course I will let you know verification of coverage is not a guarantee of payment for claims. So for this policy office visits themselves are not covered however treatment received in office could be so if it was simply like a consultation um.
[CUSTOMER][NEUTRAL] the
[CUSTOMER][NEUTRAL] Ah
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Hi what's up.
[CUSTOMER][NEUTRAL] Even, yes.
[AGENT][NEUTRAL] I'm sorry?
[CUSTOMER][NEUTRAL] Treatment, yes.
[AGENT][NEUTRAL] Right, right, office treatment is covered under this policy and so their outpatient benefit.
[CUSTOMER][NEUTRAL] At 100%?
[AGENT][NEUTRAL] The outpatient benefit is on a per calendar day basis so it pays up to $500 per calendar day.
[CUSTOMER][NEUTRAL] the
[CUSTOMER][NEUTRAL] OK, up to $500 after that they're responsible.
[AGENT][POSITIVE] Correct.
[AGENT][NEUTRAL] So and that goes again towards co-pay, deductible or co-insurance.
[CUSTOMER][POSITIVE] OK, no problem.
[CUSTOMER][NEUTRAL] Got it and um is there like a reference number for the call?
[AGENT][NEUTRAL] It 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? Uh huh.
[CUSTOMER][NEUTRAL] That's
[CUSTOMER][NEUTRAL] A.
[CUSTOMER][NEUTRAL] Uh, no, that'd be all. So this is the reference, um, that I could use your name?
[AGENT][NEUTRAL] Uh, my first name, last initial, and today's date.
[CUSTOMER][POSITIVE] Got it thank you so much [PII].
[AGENT][POSITIVE] Of course, thanks for calling [PII]. I hope you have a great rest of your day.
[CUSTOMER][POSITIVE] Thank you bye bye.
[AGENT][POSITIVE] Thank you. Bye-bye.