AccountId: 011433970860
ContactId: f9c8f789-9bcc-4710-986c-ce65584c6299
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 317140 ms
Total Talk Time (AGENT): 119906 ms
Total Talk Time (CUSTOMER): 113987 ms
Interruptions: 1
Overall Sentiment: AGENT=0.7, CUSTOMER=0.4
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/03/13/f9c8f789-9bcc-4710-986c-ce65584c6299_20250313T17:08_UTC.wav
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[AGENT][POSITIVE] Good afternoon. Thank you for calling APL. This is [PII]. How may I assist you?
[CUSTOMER][NEUTRAL] Uh yeah, hi. Uh, my name is [PII] I'm from provider's office. So today I have one patient and I'm just looking for benefits.
[AGENT][NEUTRAL] Mhm.
[AGENT][NEUTRAL] OK, sure. I can assist you with benefits, Mr. [PII] May I have a callback number just in case we get disconnected and the name of the facility that you're calling from?
[CUSTOMER][NEUTRAL] Are you sure. Uh, callback number is [PII].
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] And I'm from, uh, like facility name is Hematology oncology Associates.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] Mm
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] Thank you. And may I have the patient's policy number, Mr. [PII]?
[CUSTOMER][NEUTRAL] It
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Uh, sure. It's 022 03919 M as in Mike, L as in Lima 7.
[AGENT][NEUTRAL] OK. Mm.
[CUSTOMER][NEUTRAL] And
[AGENT][NEUTRAL] What's the name and date of birth of the patient?
[CUSTOMER][NEUTRAL] And just a moment.
[CUSTOMER][NEUTRAL] Right. Uh, patient name is [PII]. Date of birth is [PII].
[AGENT][POSITIVE] OK, thank you.
[AGENT][NEUTRAL] And this is gonna be for an office setting or outpatient facility?
[CUSTOMER][NEUTRAL] Uh, for office visit.
[AGENT][NEUTRAL] OK. And before I give you any benefit information, I need to let you know that this is not a guarantee of payment, just a verification of coverage and that's just a disclaimer.
[CUSTOMER][NEUTRAL] Mhm. OK.
[AGENT][NEUTRAL] And with this one, this is one of our secondary policies to the major medical.
[AGENT][NEUTRAL] And we, we cover office procedures. We do not cover the office visit, but we do cover the office procedures. The office procedures are subject to the outpatient maximum which is 6000 per covered person per calendar year.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK and.
[CUSTOMER][NEUTRAL] So this policy is not covered uh for office visit?
[AGENT][NEUTRAL] No, office visit co-payments are not covered under this policy. We only cover the procedures.
[CUSTOMER][NEUTRAL] Only covers the procedures, right?
[AGENT][POSITIVE] Mhm, correct.
[CUSTOMER][NEUTRAL] I.
[CUSTOMER][NEUTRAL] Just don't
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] So this policy is supplement policy or what kind of policy is this?
[AGENT][NEUTRAL] This is
[AGENT][NEUTRAL] Yeah, this is a secondary supplemental plan to the major medical, that is correct.
[CUSTOMER][NEUTRAL] OK. Uh, so is there any plan type for this policy?
[AGENT][NEUTRAL] No, there's no plan type.
[CUSTOMER][NEUTRAL] OK. Uh, any, uh, deductible or any out of pocket amount?
[AGENT][NEGATIVE] Not with us, no.
[CUSTOMER][NEUTRAL] All right.
[CUSTOMER][NEUTRAL] So, uh, according to these policies only covers procedures. And for [PII], yearly limit is 6 $6000 right?
[AGENT][NEUTRAL] Mhm
[AGENT][POSITIVE] Correct, yes, that is correct.
[CUSTOMER][NEUTRAL] OK. So this policy uh cover
[CUSTOMER][NEUTRAL] For like.
[CUSTOMER][NEUTRAL] Uh, could you please one more time, uh,
[CUSTOMER][NEUTRAL] Explain
[CUSTOMER][NEUTRAL] Like what type of uh you know, benefits and
[AGENT][NEUTRAL] With this policy, this policy covers procedures done in the office. So any procedure done in the office is covered by this policy, um, up to the maximum of 6000 per covered person per calendar year. What we do is we help with the deductibles, co-payment, and co-insurance from the major medical for procedures only for treatment or procedures. We do not cover the co-payment for the visit.
[CUSTOMER][NEUTRAL] OK. All right, got it.
[CUSTOMER][NEUTRAL] OK. And uh this policy is a medical policy, right?
[AGENT][NEUTRAL] Yes, it's, it's a secondary medical, correct.
[CUSTOMER][NEUTRAL] OK. All right. Got it. OK, thank you so much for this information. Uh, may I know your first name and last name, sir?
[AGENT][NEUTRAL] Mm.
[AGENT][NEUTRAL] That's [PII].
[CUSTOMER][NEUTRAL] All right. And is there any call reference number?
[AGENT][NEUTRAL] We don't have reference numbers, you can use my name and today state if you will.
[CUSTOMER][POSITIVE] All right, no problem.
[CUSTOMER][POSITIVE] OK, got it. Thank you so much for this information. Have a wonderful day. Bye-bye.
[AGENT][POSITIVE] You as well. Thank you for calling ATM. Bye-bye.