AccountId: 011433970860
ContactId: fa63cf2e-485c-472f-bde3-605f19a321bf
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 807619 ms
Total Talk Time (AGENT): 286928 ms
Total Talk Time (CUSTOMER): 134724 ms
Interruptions: 1
Overall Sentiment: AGENT=0.9, CUSTOMER=0.7
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/03/03/fa63cf2e-485c-472f-bde3-605f19a321bf_20250303T21:26_UTC.wav
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[AGENT][NEUTRAL] Thank you for calling APL. This is [PII]. How can I help you?
[CUSTOMER][NEUTRAL] Hi [PII], this is [PII]. I'm calling to get infertility benefits. By the way, what's the initial to your last name?
[AGENT][NEUTRAL] [PII] and yours?
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] OK, [PII], and you're needing eligibility and benefit information for a member, is that correct?
[CUSTOMER][POSITIVE] That's correct, yeah.
[AGENT][POSITIVE] Yes ma'am, I can help you. And what is your callback number?
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] OK, thank you and the member's policy number please, [PII].
[CUSTOMER][NEUTRAL] And number 02498728.
[AGENT][NEUTRAL] OK, thank you. One moment please.
[CUSTOMER][NEUTRAL] Sure.
[AGENT][NEUTRAL] OK, and any information that I do provide for you today would be a verification of benefits and not a guarantee of payment. What is your patient's name please and date of birth?
[CUSTOMER][NEUTRAL] Um, [PII]. Date of birth.
[CUSTOMER][NEUTRAL] [PII]
[CUSTOMER][NEUTRAL] [PII].
[AGENT][POSITIVE] Thank you.
[AGENT][NEUTRAL] OK, so I do see that she is the spouse of the subscriber on this limited benefit plan. This is not major medical insurance, then it is a limited benefit plan and you said that you were needing benefit information regarding to fertility, is that correct?
[CUSTOMER][NEUTRAL] Yes, infertility.
[AGENT][NEUTRAL] Infertility, OK, let me see if that is covered under this policy. Just one moment.
[CUSTOMER][NEUTRAL] All right, so not a major medical insurance.
[AGENT][NEGATIVE] No, ma'am, it is not.
[AGENT][NEUTRAL] OK, you just give me a couple of minutes please to look through her benefit information.
[CUSTOMER][POSITIVE] All right, thank you.
[AGENT][POSITIVE] You're welcome.
[AGENT][NEUTRAL] Just a moment.
[AGENT][NEUTRAL] OK, bear with me just a couple of minutes because I'm gonna have to check on this. I'm not.
[AGENT][NEUTRAL] I'm not certain and I don't wanna give you an incorrect answer.
[CUSTOMER][NEUTRAL] Alright.
[AGENT][NEUTRAL] I don't believe that it is covered, but I want to double check that.
[CUSTOMER][POSITIVE] All right, thank you.
[AGENT][POSITIVE] Yes, ma'am. You're certainly welcome and thank you for your patience.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] OK. So on this limited benefit plan, the, she has an outpatient benefit related uh to sickness, which is a $75 per visit.
[AGENT][POSITIVE] Benefit and a max number of visits per calendar year.
[AGENT][NEUTRAL] That is going to be just one moment.
[AGENT][NEUTRAL] 75. OK, again. Mhm.
[CUSTOMER][NEUTRAL] Um, so
[AGENT][NEUTRAL] With a max of 5 visits per calendar year, but again, because this is not major medical.
[CUSTOMER][NEUTRAL] So there is a coverage for in for the
[AGENT][NEUTRAL] Insurance
[CUSTOMER][NEUTRAL] Sorry about that. Um, so there is a coverage, um, so there is a coverage for infertility.
[AGENT][NEUTRAL] That's OK.
[AGENT][NEUTRAL] The only benefit she has is for an office visit.
[AGENT][NEUTRAL] And that max benefit is $75 per visit, with a maximum of 5 visits per calendar year.
[CUSTOMER][NEUTRAL] Oh right.
[AGENT][NEUTRAL] That is the only benefit available on this policy.
[CUSTOMER][NEUTRAL] One second, so check.
[CUSTOMER][NEUTRAL] $75.
[AGENT][NEUTRAL] Per visit, a maximum of 5 visits per calendar year.
[CUSTOMER][NEUTRAL] The calendar here.
[AGENT][NEUTRAL] Yeah
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] So that's the only thing that she has on her insurance.
[AGENT][NEUTRAL] Yes, ma'am. Uh-huh. For, for this, for this, what you're inquiring about.
[CUSTOMER][NEUTRAL] Our
[CUSTOMER][NEUTRAL] But no coverage for diagnostic testing and treatment, right?
[AGENT][POSITIVE] Correct.
[CUSTOMER][NEUTRAL] And she has, does she have basic medical?
[AGENT][NEUTRAL] Again, this is only a hospital indemnity limited benefit plan.
[AGENT][NEUTRAL] It is not any form of major medical insurance.
[CUSTOMER][NEUTRAL] All right.
[CUSTOMER][NEUTRAL] So I won't have accumulations for deductible and out of pocket, correct?
[AGENT][POSITIVE] No, that is correct.
[CUSTOMER][NEUTRAL] One second.
[CUSTOMER][NEUTRAL] Um, does she have a pharmacy benefit manager?
[AGENT][NEUTRAL] Let me look at her ID card to see about their pharmacy information.
[CUSTOMER][NEUTRAL] All right.
[CUSTOMER][NEUTRAL] So the $75 is for a specialist visit?
[AGENT][NEUTRAL] Yes, ma'am. Mhm.
[CUSTOMER][NEUTRAL] Or even, oh our.
[CUSTOMER][NEUTRAL] $75.
[AGENT][NEUTRAL] Yes, ma'am. That's, that's right. Regardless of the type of provider or specialty it is, that is the max visit and the max number of visits per calendar year available on this coverage.
[AGENT][NEUTRAL] And for any pharmacy-related questions.
[AGENT][NEUTRAL] You would contact Farmavale.
[AGENT][NEUTRAL] I can provide you their customer service. Farmmavale P H A R M A B A I L.
[CUSTOMER][NEUTRAL] Farmma Bain.
[CUSTOMER][NEUTRAL] V for Victor, correct?
[CUSTOMER][NEUTRAL] Armo
[AGENT][NEUTRAL] Farm, farmail, uh-huh.
[CUSTOMER][NEUTRAL] All right, um, the number, please?
[AGENT][NEUTRAL] For customer service, it's [PII].
[AGENT][NEUTRAL] They also have a separate number for a pharmacy help desk.
[AGENT][POSITIVE] But I don't know if that is strictly for, you know, pharmacy, but I'll be happy to provide that one to you as well.
[CUSTOMER][NEUTRAL] So can I have the number, please?
[AGENT][NEUTRAL] [PII].
[AGENT][NEUTRAL] And I can give you the VIN number and the group number and the PCN number associated with that.
[CUSTOMER][POSITIVE] It's all right.
[AGENT][NEUTRAL] You don't need that? OK.
[CUSTOMER][NEUTRAL] No.
[CUSTOMER][POSITIVE] Thank you.
[AGENT][POSITIVE] Yes ma'am, you're welcome.
[CUSTOMER][NEUTRAL] Customer serv[PII].
[AGENT][NEUTRAL] Now should you all end up filing a claim with APL for her [PII] once we have processed the claim.
[AGENT][NEUTRAL] We do have a portal in which you should be able to check claim status and our portal website is located at [PII].
[AGENT][NEUTRAL] [PII].
[CUSTOMER][NEUTRAL] [PII]
[AGENT][NEUTRAL] Uh-huh, with a [PII] Yes, ma'am.
[CUSTOMER][NEUTRAL] Um, [PII].
[AGENT][NEUTRAL] [PII]. Yes, ma'am.
[CUSTOMER][NEUTRAL] This is for claims, correct?
[AGENT][NEUTRAL] Uh-huh. Once the claim has been processed, just saying you should be able to check status in that portal.
[AGENT][NEUTRAL] And it's a self-registering portal.
[CUSTOMER][NEUTRAL] All right. Um.
[AGENT][NEUTRAL] And is there
[CUSTOMER][NEUTRAL] No, um, does this one runs in the calendar or plan year?
[AGENT][NEUTRAL] Calendar
[CUSTOMER][NEUTRAL] What's the original effective date of the plan?
[AGENT][NEUTRAL] The original effective date on this policy, as I mentioned before, is going to be [PII].
[CUSTOMER][NEUTRAL] And she is a subscriber, correct?
[AGENT][NEUTRAL] She is not. She is the spouse.
[CUSTOMER][NEUTRAL] Oh, spouse, so [PII] is the subscriber.
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Alrighty, I think that's it for me. Can I have the reference number for this call?
[AGENT][NEUTRAL] Yes, ma'am, you would use my name along with today's date.
[CUSTOMER][NEUTRAL] All right
[CUSTOMER][POSITIVE] Thank you so much. I appreciate it. Have a great day.
[AGENT][POSITIVE] OK. Well, you're very welcome.
[AGENT][NEUTRAL] You too, [PII]. Is there anything else I can help you with?
[CUSTOMER][POSITIVE] No, that's it for me. Thank you.
[AGENT][POSITIVE] OK, well, you're welcome and thank you again for calling APL. I hope you have a very nice evening.
[CUSTOMER][NEUTRAL] You too. Bye-bye.
[AGENT][POSITIVE] Yes, ma'am. Thank you. Bye-bye.