AccountId: 011433970860
ContactId: 010785af-c6b4-4468-943e-693169a4e055
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 243919 ms
Total Talk Time (AGENT): 129811 ms
Total Talk Time (CUSTOMER): 87215 ms
Interruptions: 1
Overall Sentiment: AGENT=0.2, CUSTOMER=0.3
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/02/14/010785af-c6b4-4468-943e-693169a4e055_20250214T17:45_UTC.wav
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[AGENT][NEUTRAL] Good morning. Thank you for calling APL. This is [PII]. How may I assist you?
[CUSTOMER][NEUTRAL] Oh yeah, I'm calling to see what number is active.
[AGENT][NEUTRAL] OK, sure. I can assist you with the eligibility. May I have your name?
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] OK, and may I have a callback number just in case we get disconnected?
[CUSTOMER][NEUTRAL] Yes, [PII].
[AGENT][NEUTRAL] Yeah, and you're calling from which facility or provider?
[CUSTOMER][NEUTRAL] A provider.
[AGENT][NEUTRAL] What's the name for my notation?
[CUSTOMER][NEUTRAL] [PII] from Bon D Holding.
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] That's you.
[AGENT][NEUTRAL] Thank you. And um let me have the policy number of the patient, Ms. [PII].
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Yeah it is uh 01659591.
[AGENT][NEUTRAL] OK, what's the name and date of birth of the patient?
[CUSTOMER][NEUTRAL] [PII] and it's [PII].
[AGENT][NEUTRAL] OK. Can we have an effective date of [PII]. It is active at the moment and this is one of our secondary supplemental plans to the major medical.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Yeah
[CUSTOMER][NEUTRAL] What does it cover?
[AGENT][NEUTRAL] OK, let me check the benefits and this is not a guarantee of payment, just a verification of coverage and that's just a disclaimer.
[CUSTOMER][NEUTRAL] This
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] And let's see.
[AGENT][NEUTRAL] So for this one, it covers um looks like just the office treatment. Let me double check one moment.
[AGENT][NEUTRAL] Alright.
[CUSTOMER][NEUTRAL] They they they.
[AGENT][NEUTRAL] OK, so it has the office treatment rider which it covers the office treatment and this is subject to the outpatient maximum and that is the.
[AGENT][NEUTRAL] 7900 per cover person per calendar year.
[CUSTOMER][NEUTRAL] How much did you say?
[AGENT][NEUTRAL] 7900 per cover person per calendar year for outpatient service.
[CUSTOMER][NEUTRAL] Let me just write it here hang on I'm sorry.
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Not
[CUSTOMER][NEUTRAL] No, right.
[CUSTOMER][NEUTRAL] My [PII], it's a
[CUSTOMER][NEUTRAL] OK, and so it covers, uh, deductible ways and anything done, right?
[AGENT][NEUTRAL] I'm sorry, can you repeat that?
[CUSTOMER][NEUTRAL] Covers the copays and deductibles and anything the patient has done.
[AGENT][NEUTRAL] If it's treatments or procedures, yes. Um, I'm checking on the visit. I don't think it covers the visit, but I'm checking, I'm double checking just to make sure, OK.
[CUSTOMER][NEUTRAL] Yeah, because she's coming in for an office visit and she says that she should be covered.
[AGENT][NEUTRAL] OK. Mhm. Yeah, there is an office visit benefit. Is, um, is, is this a specialist or is this a PCP?
[CUSTOMER][NEUTRAL] Yeah
[CUSTOMER][NEUTRAL] Specialist.
[AGENT][NEUTRAL] OK, for the specialist, it covers up to $50 per visit, maximum of 4 visits per covered person per calendar year.
[CUSTOMER][NEUTRAL] OK, and how many has she used this year?
[AGENT][NEUTRAL] Um, let me check.
[CUSTOMER][NEUTRAL] Yeah.
[AGENT][NEUTRAL] Right.
[AGENT][NEUTRAL] She has not used her benefits uh of today for [PII], so she still have all available all four.
[CUSTOMER][NEUTRAL] So she has
[CUSTOMER][POSITIVE] Perfect. OK and then what can I use for reference?
[AGENT][NEUTRAL] Mhm
[AGENT][NEUTRAL] We don't have reference numbers. You can use my name in today's date if you would like, Miss [PII]. Do you need the spelling of my name?
[CUSTOMER][NEUTRAL] Yes.
[CUSTOMER][NEUTRAL] Yes mhm.
[AGENT][NEUTRAL] OK, that's [PII].
[CUSTOMER][NEUTRAL] Hold on, uh, what I'm sorry?
[AGENT][NEUTRAL] [PII].
[CUSTOMER][POSITIVE] Perfect. And today's date. OK, that's what I needed thank you.
[AGENT][NEUTRAL] Mhm.
[AGENT][POSITIVE] You're welcome and thank you for calling APL. Have a good day.
[CUSTOMER][NEUTRAL] Bye.
[AGENT][NEUTRAL] Mhm.