AccountId: 011433970860
ContactId: f9b08cba-d146-48f1-95a6-bbc633d49bbb
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 269510 ms
Total Talk Time (AGENT): 132905 ms
Total Talk Time (CUSTOMER): 85466 ms
Interruptions: 0
Overall Sentiment: AGENT=1.6, CUSTOMER=0.2
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/06/18/f9b08cba-d146-48f1-95a6-bbc633d49bbb_20250618T16:33_UTC.wav
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[AGENT][NEUTRAL] Thank you for calling APL. This is. How can I help you?
[CUSTOMER][NEUTRAL] Yes, hello, uh, my name is [PII]. I'm calling from Doctor [PII]'s office. I need to go with benefits on the patient's gap plan.
[AGENT][POSITIVE] Sure, I can check those benefits for you. uh [PII], can I get a good call back number from you first in case we're disconnected?
[CUSTOMER][NEUTRAL] The callback number is [PII].
[AGENT][NEUTRAL] Thank you. And then do you have that policy number?
[CUSTOMER][NEUTRAL] I have um 0193598.
[CUSTOMER][NEUTRAL] Wait, let me go into a patient's chart because I wrote it down and I can't even read the writing. I think it's 89 ML. Let me see.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] Sure.
[CUSTOMER][NEUTRAL] Hold on [PII].
[CUSTOMER][NEUTRAL] So it is 01935980 ML.
[AGENT][NEUTRAL] 0, OK.
[AGENT][NEUTRAL] Alright, one moment.
[CUSTOMER][NEUTRAL] Is it ML 8 at the end?
[AGENT][NEUTRAL] Um, honestly, it's so ML 8 would be for um outpatient services. ML7 would be for inpatient, but the digits before the M are the policy number, so that's perfectly fine.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] OK, um, and then what was the name and date of birth for the member please?
[CUSTOMER][NEUTRAL] Patient's name is [PII]. Date of birth is [PII].
[AGENT][NEUTRAL] OK, thank you for verifying that. Uh, so this policy, uh, terminated [PII]. If you'll give me one moment, I'll see if he has one that's active, might just be a different policy number.
[CUSTOMER][POSITIVE] All right thank you.
[AGENT][NEUTRAL] Sure.
[AGENT][NEUTRAL] OK, so he does have one that is currently active. Let me know when you're ready and I'll give you that updated policy number.
[CUSTOMER][NEUTRAL] OK, let me put, I had to archive the other one, so let me put this in so it's with APL, right? APL, yes.
[AGENT][NEUTRAL] Mhm. Sure.
[AGENT][POSITIVE] Correct.
[CUSTOMER][NEUTRAL] Alright
[CUSTOMER][NEUTRAL] The payer ID is 60801.
[AGENT][POSITIVE] Correct.
[CUSTOMER][NEUTRAL] Alright, and the policy number?
[AGENT][NEUTRAL] It is 01.
[AGENT][NEUTRAL] 83
[AGENT][NEUTRAL] 5092.
[CUSTOMER][NEUTRAL] So that is 01835092.
[AGENT][NEUTRAL] Correct, uh, and again this one is currently active. That effective date was [PII].
[CUSTOMER][NEUTRAL] OK, so does this gap plan cover procedures in the doctor's office?
[AGENT][NEUTRAL] I can definitely check to see if office visits are covered. um I will let you know uh that as this is a secondary medical policy, it is very dependent on his major medical so is designed to help with co-pay, deductible and co-insurance after major medical pays and of course I will also let you know verification of coverage is not a guarantee of payment for claims um so on this policy office visits are not covered however treatment received in office is.
[CUSTOMER][NEUTRAL] OK, so, so biopsies, you know, a procedure runs in the office will be covered. He has a deductible of 1500, so up to how much would the, um, gap plan cover?
[AGENT][POSITIVE] That's correct.
[AGENT][POSITIVE] That's correct, yes.
[AGENT][NEUTRAL] So yes, his outpatient benefit is $1500 per calendar year, so it would cover up to that amount per calendar year.
[CUSTOMER][NEUTRAL] And does he still have that available?
[AGENT][POSITIVE] I could definitely see how much of that he has used. Give me just a moment.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] So he has, he only used $30 of that benefit so far this year.
[CUSTOMER][NEUTRAL] OK. All right, great. May I have a reference number for the call?
[AGENT][NEUTRAL] Sure, that would just be my first name, last initial, and today's date. And so my name is spelled [PII] Was there anything else I could help you with?
[CUSTOMER][NEUTRAL] So
[CUSTOMER][NEUTRAL] No, that's all. [PII] All right, thank you.
[AGENT][POSITIVE] Correct, of course, thanks for calling APL. Have a great rest of your day bye bye.
[CUSTOMER][NEUTRAL] All right bye bye.
[CUSTOMER][NEUTRAL] You too bye bye.