AccountId: 011433970860
ContactId: feec604f-301c-4794-9444-ff41860854f0
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 552500 ms
Total Talk Time (AGENT): 236303 ms
Total Talk Time (CUSTOMER): 215123 ms
Interruptions: 0
Overall Sentiment: AGENT=0.6, CUSTOMER=0.7
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/01/07/feec604f-301c-4794-9444-ff41860854f0_20250107T19:52_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, good afternoon, this is [PII]. Uh, I'm trying to confirm benefits for a patient.
[AGENT][POSITIVE] Sure, I can assist you with benefits, Ms. [PII], and may I have a callback number just in case we get disconnected?
[CUSTOMER][NEUTRAL] Yeah, it's [PII], no extension.
[AGENT][NEUTRAL] OK, thank you. And may I have the patient's policy number?
[CUSTOMER][NEUTRAL] Sure. It's, uh, give me a second, please.
[AGENT][NEUTRAL] Mm
[CUSTOMER][NEUTRAL] OK. It's 02583654.
[AGENT][NEUTRAL] Thank you. May I have the name and date of birth of the patient?
[CUSTOMER][NEUTRAL] Sure. Last, last name, I'm sorry, is [PII] or [PII]. Um, first name is [PII] and the date of birth is [PII].
[AGENT][NEUTRAL] OK, thank you. And what type of service is being rendered for benefits?
[CUSTOMER][NEUTRAL] Oh, OK. I need PCPs office visit, um, telehealth surgery done in the office, diagnostic labs done in the office too, um, routine physical exam or annual wellness. And I need to confirm the benefit also for, uh, 3 CBT codes, 2 are for vaccines and 1 for COVID test done in the office. Is it possible?
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] Bear with me just a second because this is one of our limited hospital indemnity plan. Um, it does have a limited benefit. Um, let me just go ahead and pull the certificate with the information, and this is not a guarantee of payment, just a verification of coverage and that's just a disclaimer. And let's see, so for the office visit.
[CUSTOMER][NEUTRAL] Oh.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK, sure.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] Um, we have $100 per visit, maximum of 4 visits per cover person per calendar year.
[CUSTOMER][NEUTRAL] Mhm
[AGENT][NEUTRAL] And the $100 is a flat amount. So anything over is members responsibility. And um let me check diagnostic testing. Now, this one doesn't cover preventative, um.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] Wellness is not covered, um.
[CUSTOMER][NEUTRAL] Oh, OK. Uh, for example, the annual physical exam or annual wellness not covered, right?
[AGENT][NEGATIVE] Well, this is not covered at all.
[CUSTOMER][NEUTRAL] OK. Uh, same case for immunization that's prevented?
[AGENT][NEGATIVE] Yeah, that's, that's preventive immunizations are not covered under this policy.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] Mm
[AGENT][NEUTRAL] Do you have any other questions for me Miss [PII]?
[CUSTOMER][NEUTRAL] Um, uh, I'm so sorry, um, OK, just to be sure, um, OK, you told me for the PCBC office visit and apart from that, um, the other, uh, benefits, uh, I mentioned the surgery and labs are not covered also.
[AGENT][NEUTRAL] Labs are not covered. Mhm.
[CUSTOMER][NEUTRAL] Or just uh.
[CUSTOMER][NEUTRAL] OK
[AGENT][NEUTRAL] And what's the other testing?
[CUSTOMER][NEUTRAL] Minor surgery, uh, uh-huh, minor, uh, minor surgery done in the office.
[AGENT][NEUTRAL] Surgery. OK. Let me give you the benefit for the surgery. One moment, let me pull that one.
[CUSTOMER][POSITIVE] Thank you.
[AGENT][POSITIVE] You're welcome.
[AGENT][NEUTRAL] OK, so for surgery done in office, it's going to be 250 per surgery and maximum of 2 per covered person per calendar year.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Mm.
[CUSTOMER][NEUTRAL] OK, is it telehealth cover?
[AGENT][NEUTRAL] Telehealth, I believe it's gonna be through another company. Let me check really quick on the card.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][POSITIVE] Thank you.
[AGENT][NEUTRAL] Yeah.
[AGENT][NEUTRAL] All right. So, um, virtual urgent care, uh, let's see.
[AGENT][NEUTRAL] It's under Virgil care benefits in a card.
[CUSTOMER][POSITIVE] Oh, I'm sorry.
[AGENT][NEUTRAL] And the company is gonna be under virtual, um, virtual care benefits in a car, that's what it says. Virtual care, yes.
[CUSTOMER][NEUTRAL] Oh, OK.
[CUSTOMER][NEUTRAL] Oh, OK, because yeah, I think it's, uh, we're all, I'm sorry, we're using our own platform, so.
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Um,
[CUSTOMER][NEUTRAL] And, OK, um, is it show up if this plan has um any HSC or HRA, the member?
[AGENT][NEUTRAL] I'm sorry, can you repeat that? You sound far away from the phone. Can you repeat that?
[CUSTOMER][NEUTRAL] Yeah, if, uh, if it's shown on file, if is there any HSA or HRA for this account called savings account?
[AGENT][NEGATIVE] Oh, no. Mm mm.
[AGENT][NEUTRAL] No, this is a limited policy, so it's not gonna show that information. Mhm.
[CUSTOMER][NEUTRAL] OK got it and.
[CUSTOMER][NEUTRAL] OK, and um may I ask you for the, um, oh no, I'm sorry, I have the effective date for the member. um for this one, is there any PCP assigned or if it's not required to see the patient?
[AGENT][NEUTRAL] It's not required. There's no network.
[CUSTOMER][NEUTRAL] OK, got it. Um, sorry, may I confirm the plan type CPO HMO, ASO.
[AGENT][NEUTRAL] There's no time. It's just a limited hospital indemnity plan.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Mhm
[CUSTOMER][NEUTRAL] Give me just a second please.
[AGENT][NEUTRAL] I'm sorry?
[CUSTOMER][NEUTRAL] Oh, give me just a second please.
[AGENT][NEUTRAL] Oh sure, yes.
[CUSTOMER][NEUTRAL] And you mentioned no network?
[AGENT][NEUTRAL] There's no network if the provider participates with multi plan they get that additional discount but it's not something that is required.
[CUSTOMER][NEUTRAL] OK
[CUSTOMER][NEUTRAL] OK, got it. um, is it showing any coordination of benefits for this mem[PII] plan?
[AGENT][NEUTRAL] Mhm.
[AGENT][NEGATIVE] We don't coordinate benefits for this one.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] And may I ask if is there any um group number?
[AGENT][POSITIVE] Yes, let me get the group number, yes.
[CUSTOMER][NEUTRAL] For billing purposes.
[CUSTOMER][POSITIVE] Thank you
[AGENT][POSITIVE] You're welcome.
[AGENT][NEUTRAL] OK, Ms. [PII], the group number is 70073.
[CUSTOMER][NEUTRAL] OK, got it. And um yeah, to be pretty sure, I'm sorry, for this member's plan, is there any um or does it have any deductible not out of pocket?
[AGENT][NEUTRAL] No.
[AGENT][NEUTRAL] No.
[CUSTOMER][NEUTRAL] OK, got it.
[AGENT][NEUTRAL] OK
[CUSTOMER][POSITIVE] Thank you so much for that. I need to be pretty sure about this.
[AGENT][POSITIVE] Yes, it's OK, no problem.
[CUSTOMER][NEUTRAL] And
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK, as a final question, I'm sorry for this. May I ask again for the telehealth because I'm not pretty sure about the answer you gave me before.
[AGENT][NEUTRAL] OK
[AGENT][NEUTRAL] OK, um, like if they use, uh, the, if they have to call to get assistance through the phone and it's, yeah, and it's charged as an office visit and then it will be under the office visit benefit. Now, usually, um, yeah, they have a, a card and they have this place where they go through virtual care to get virtual care, so.
[CUSTOMER][NEUTRAL] The on platform
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Sure.
[AGENT][NEUTRAL] Um, but if you have like the capability of them to call um virtually to the office and do an office visit or, you know, consultation over the phone and is charged as an office visit, they can send in the claim for an office visit. It's considered an office visit. Mhm mhm.
[CUSTOMER][NEUTRAL] OK, got it.
[CUSTOMER][POSITIVE] Perfect. Now I got it. Thank you so much for the explanation. So yeah, that's all the information I was trying to confirm. Um, may I ask you for a reference, sorry, for your name again for my notes and a reference number for this call?
[AGENT][POSITIVE] You're welcome.
[AGENT][NEUTRAL] Mm.
[AGENT][NEUTRAL] Sure. My name is [PII], and we don't have reference numbers. You can use my name in today's date.
[CUSTOMER][POSITIVE] OK, got it then so so thank you so much for all the information and for taking my call today.
[AGENT][POSITIVE] You're welcome, Ms. [PII], and thank you for calling APL. Have a good afternoon, OK?
[CUSTOMER][NEUTRAL] You too bye bye for now.
[AGENT][POSITIVE] Thank you. Goodbye.
[CUSTOMER][NEUTRAL] Bye bye.