AccountId: 011433970860
ContactId: fd6d3e72-f128-4f31-b7b6-716dff9bc453
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 258238 ms
Total Talk Time (AGENT): 117699 ms
Total Talk Time (CUSTOMER): 76305 ms
Interruptions: 0
Overall Sentiment: AGENT=1.1, CUSTOMER=1
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/05/16/fd6d3e72-f128-4f31-b7b6-716dff9bc453_20250516T14:10_UTC.wav
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[AGENT][POSITIVE] Good morning. Thank you for calling APL. My name is [PII]. How may I help you?
[CUSTOMER][NEUTRAL] Hi, good morning. I'm calling from Children's Skin Center just to check the eligibility and benefits of a patient that I had in the office.
[AGENT][POSITIVE] OK, well, I'll be more than happy to help you with the eligibility. May I have your name and a good contact number in case we're disconnected?
[CUSTOMER][NEUTRAL] First name would be [PII] last [PII] [PII]. Callback number [PII].
[AGENT][NEUTRAL] Thank you for that. And may I have the member's policy number?
[CUSTOMER][NEUTRAL] It'll be 15493.
[AGENT][NEUTRAL] The, the, um, do you have a copy of their APL ID card there?
[CUSTOMER][NEUTRAL] Yes.
[AGENT][NEUTRAL] OK, that might be the group number. Do you see anywhere that says policy er number?
[CUSTOMER][NEUTRAL] Yes, let me give you that number 025.
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] 018.
[CUSTOMER][NEUTRAL] 21 M as in Mary, L as in long, 8.
[AGENT][NEUTRAL] Thank you, hold on one moment.
[AGENT][NEUTRAL] And can you verify the member's first and last name and date of birth?
[CUSTOMER][NEUTRAL] First name would be [PII], last name [PII]. Date of birth [PII].
[AGENT][NEUTRAL] Thank you for that and all the information provided is a verification of benefits, not a guarantee of payment. So this policy is active. It's been effective since [PII].
[AGENT][NEUTRAL] And did you need to go over any benefits?
[CUSTOMER][NEUTRAL] Was there a termination date or none?
[AGENT][NEUTRAL] Oh, none.
[CUSTOMER][NEUTRAL] OK, and then it's a gap insurance or is there any exclusions or will it cover anything, any procedures that the primary does not cover?
[AGENT][NEUTRAL] No, we pay towards the copay, deductible and co-insurance after primary. The policy does have benefits of its own, separate from the, I'm sorry, secondary, has benefits um separate from primary.
[CUSTOMER][NEUTRAL] OK, could you go over those benefits?
[AGENT][NEUTRAL] Sure. Are you outpatient?
[CUSTOMER][NEUTRAL] So
[CUSTOMER][POSITIVE] It yes
[AGENT][NEUTRAL] OK, hold on one moment.
[AGENT][NEUTRAL] So for outpatient, the policy will pay up to $2500 per calendar year.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] There's no um office coverage for the policy, but they do have the office treatment rider. So any treatment in the office could be covered as long as it's not cosmetic. And you know what, hold one moment cause I see an office visit writer.
[AGENT][NEUTRAL] Hold on 1 2nd.
[AGENT][NEUTRAL] OK, so for the, um, you said specialist?
[CUSTOMER][POSITIVE] Correct.
[AGENT][NEUTRAL] For the specialist office, um, visit fee, um, the policy would pay up to $50 per visit with a max of 4 visits per calendar year.
[AGENT][NEUTRAL] So this policy does pay towards the um facility.
[CUSTOMER][NEUTRAL] OK, perfect, so it pays up to $50 for up to 4 visits you said right?
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] And that's 4 visits per calendar year?
[AGENT][NEUTRAL] And then
[AGENT][NEUTRAL] Yes, that and the um the treatment would be with that max of 2500 per year.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK perfect and then you said they'll cover the procedures excluding anything that's considered cosmetic.
[AGENT][POSITIVE] Correct.
[CUSTOMER][POSITIVE] All right perfect thank you so much what was your name again?
[AGENT][NEUTRAL] My name is [PII]. First initial and my last name is [PII].
[CUSTOMER][NEUTRAL] And then do you have a reference number for this call?
[AGENT][NEUTRAL] So there's no call reference number, but you can use my name and today's date.
[CUSTOMER][POSITIVE] OK perfect thank you so much and I appreciate it.
[AGENT][POSITIVE] You're very welcome. Was there anything else I can help with?
[CUSTOMER][NEUTRAL] No, that'll be all for today.
[AGENT][POSITIVE] Alright, thanks for calling APL. Have a great weekend.
[CUSTOMER][POSITIVE] Thank you too bye bye.
[AGENT][NEUTRAL] Bye bye.