AccountId: 011433970860
ContactId: f9ea7864-2541-4baa-a348-dc4121c873e2
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 346619 ms
Total Talk Time (AGENT): 155598 ms
Total Talk Time (CUSTOMER): 112966 ms
Interruptions: 0
Overall Sentiment: AGENT=1.1, CUSTOMER=0.2
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/01/23/f9ea7864-2541-4baa-a348-dc4121c873e2_20250123T20:35_UTC.wav
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[AGENT][NEUTRAL] Hi, thank you for calling APL. This is [PII]. How can I help you today?
[CUSTOMER][NEUTRAL] Hi, yes, I'm calling from South [PII] ENT to um verify eligibility and benefits for a mutual patient.
[AGENT][POSITIVE] OK, yeah, I'd love to help you with eligibility and benefits today. Um, do you mind if I get your name real quick and a good call back number?
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] Yes, my name is [PII]. It's [PII]
[CUSTOMER][NEUTRAL] And my phone number is [PII].
[AGENT][NEUTRAL] Thank you. And what's that policy number?
[CUSTOMER][NEUTRAL] 02249238.
[AGENT][NEUTRAL] 02249238
[CUSTOMER][NEUTRAL] Yeah
[CUSTOMER][POSITIVE] Correct.
[AGENT][POSITIVE] Thank you.
[AGENT][NEUTRAL] I'm just trying to get that policy loaded.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][POSITIVE] Awesome. And would you be able to verify for me, please, your patient's first and last name and date of birth?
[CUSTOMER][NEUTRAL] Yes, the first name is [PII], the last name is [PII].
[CUSTOMER][NEUTRAL] And his date of birth is [PII].
[AGENT][POSITIVE] Perfect, I do see [PII] here and.
[AGENT][NEUTRAL] This is current and active with us. It looks like his effective date is [PII].
[AGENT][NEUTRAL] Um, you said you're looking for benefits, uh, inpatient or outpatient?
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] Um, it's uh outpatient, but what, what did you say was the, um, the effective date?
[AGENT][NEUTRAL] Oh, yes, I'm sorry. [PII].
[CUSTOMER][NEUTRAL] OK, and um yes, so um what I need to know is if, if uh if the copays are covered for a specialist.
[AGENT][NEUTRAL] Mm
[AGENT][POSITIVE] Perfect.
[AGENT][NEUTRAL] Alright, I'm getting that benefit um document loaded up for you and I do wanna let you know um any benefit information I give over the phone today is always just a verification of coverage and never guarantee of payment.
[CUSTOMER][NEUTRAL] OK
[CUSTOMER][NEUTRAL] Mm mhm.
[AGENT][NEUTRAL] And I'm sorry, one second, it's.
[AGENT][NEUTRAL] Oh, loaded. I'm just scrolling down to it.
[CUSTOMER][NEUTRAL] Mhm
[CUSTOMER][NEUTRAL] Mm.
[AGENT][NEUTRAL] All right, so it looks like your insured has um
[AGENT][NEUTRAL] A benefit for outpatient treatment, um, it says in the physician's office, and that benefit amount is $25 per visit, up to 4 visits per year or up to 4 visits per person per calendar year, and 8 visits combined as a family.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] So, so it it so it's not covered.
[AGENT][NEUTRAL] Uh, up to $25.
[CUSTOMER][NEUTRAL] So it covers up to $25 for the co-pay?
[AGENT][NEUTRAL] Yes, for, um, for treatment in a physician's office.
[CUSTOMER][NEUTRAL] Um, OK, wait, so it covers up to $25 off of his co-pay from his orig from his primary insurance.
[AGENT][NEUTRAL] Yes, up to 4 visits a year.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK, what about office procedures?
[CUSTOMER][NEUTRAL] I
[AGENT][NEUTRAL] So that is treatment in a hospital outpatient facility free standing emergency care clinic care clinic, urgent care clinic, or physician's office.
[CUSTOMER][NEUTRAL] Um.
[AGENT][NEUTRAL] It's how that covers
[CUSTOMER][NEUTRAL] Mhm, uh, specialist.
[AGENT][NEUTRAL] Uh
[CUSTOMER][NEUTRAL] I'm sorry, what was that?
[AGENT][NEUTRAL] It doesn't distinguish between a specialist or a primary care, it's just considered a physician's office.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK, um, alright, so it does cover, covers both.
[AGENT][NEUTRAL] Yeah, uh, for treatment in a physician's office. I guess both in what way? Like the
[CUSTOMER][NEUTRAL] Hello? OK.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Like an office procedure, like let's say if he's gonna get ear wax taken out, it does it is it covered with the secondary?
[AGENT][NEUTRAL] Yeah, so he's covered for treatment in a physician's office up to $25 per visit.
[CUSTOMER][NEUTRAL] it
[CUSTOMER][NEUTRAL] And the and the office procedures, is that covered as well?
[CUSTOMER][NEUTRAL] uncle
[AGENT][NEUTRAL] So I can't, I guess when you're saying in in office procedures like I don't know what the procedures are it would really come down to what comes on that claim form um all I can tell you is it's treatment in a physician's office so if it's considered treatment, it's under his benefits.
[CUSTOMER][NEUTRAL] procedure
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] that
[CUSTOMER][NEUTRAL] OK, OK, what's your name?
[AGENT][NEUTRAL] [PII].
[CUSTOMER][NEUTRAL] OK, LA, and can I get a reference number please?
[AGENT][NEUTRAL] You bet you it's just gonna be my name and today's date.
[CUSTOMER][POSITIVE] OK, Ali B and today is 123 25. OK, perfect, thank you so much, [PII].
[AGENT][POSITIVE] Oh it's my pleasure thank you so much for calling APL and you have a wonderful day.
[CUSTOMER][NEUTRAL] You too. Bye bye.
[AGENT][NEUTRAL] OK.