AccountId: 011433970860
ContactId: 013a8a13-40e5-44cd-9a27-1c36b08b3c65
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 206779 ms
Total Talk Time (AGENT): 64294 ms
Total Talk Time (CUSTOMER): 88088 ms
Interruptions: 0
Overall Sentiment: AGENT=1.1, CUSTOMER=0.3
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/05/01/013a8a13-40e5-44cd-9a27-1c36b08b3c65_20250501T19:41_UTC.wav
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[AGENT][NEUTRAL] Thank you for calling APL. This is [PII]. How can I help you?
[CUSTOMER][NEUTRAL] Hi, good afternoon. I'm calling from the provider's office to get benefits and eligibility for a patient, please.
[AGENT][POSITIVE] OK, I can help you with benefits and eligibility. Could I get your name and a good callback number?
[CUSTOMER][NEUTRAL] Mhm. [PII] [PII].
[AGENT][NEUTRAL] OK, thank you, [PII]. Do you have the policy number of the patient?
[CUSTOMER][NEUTRAL] Yes, um, it's 016.
[CUSTOMER][NEUTRAL] 18446 ML 8.
[CUSTOMER][NEUTRAL] Well.
[CUSTOMER][NEUTRAL] Huh.
[AGENT][NEUTRAL] OK, thank you. And the patient name and date of birth?
[CUSTOMER][NEUTRAL] Uh, [PII], [PII].
[CUSTOMER][NEUTRAL] I mean [PII] I'm sorry, it's for the sun.
[CUSTOMER][NEUTRAL] Oh
[AGENT][NEUTRAL] Um, I show this policy term 10-1-2024. Let me see if there is an active policy.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] I'll take that
[CUSTOMER][NEUTRAL] I don't
[CUSTOMER][NEUTRAL] Um
[AGENT][NEUTRAL] OK, yes, it looks like there's a more recent policy. Let me give you that number.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] 256-3062.
[CUSTOMER][NEUTRAL] OK
[AGENT][NEUTRAL] And let's see, that this policy is effective and active 10-12024.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] Are you needing outpatient benefits?
[CUSTOMER][NEUTRAL] Opatient, yes.
[AGENT][NEUTRAL] This is not a guarantee of payment. It's a basic outline of the policy.
[AGENT][NEUTRAL] Get that pulled up. Hold on one moment.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Yeah
[CUSTOMER][NEUTRAL] Yeah.
[AGENT][NEUTRAL] OK, so for their outpatient benefit, they have a $2000 per covered person per calendar year maximum payout.
[CUSTOMER][NEUTRAL] Yeah
[CUSTOMER][NEUTRAL] Per time of the year per person, right, per person.
[AGENT][NEUTRAL] Yes.
[CUSTOMER][NEUTRAL] OK, and what is the status now? So the insurance will cover when they come in, does it cover like the deductible or just the copay?
[AGENT][NEUTRAL] So, once the primary insurance processes the claim, this will pay for outpatient services up to $2000.
[CUSTOMER][NEUTRAL] You can
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Oh, I see.
[CUSTOMER][POSITIVE] OK, OK, perfect. OK, thank you so much, [PII]. I appreciate the information given. um, may I have a reference number just for my notes please?
[AGENT][NEUTRAL] A reference number is my name, [PII], first initial to last name [PII], and today's date. And anything else I can help with today, [PII]?
[CUSTOMER][NEUTRAL] Um, actually I just wanna go over the member ID real quick. It's, I just wanna go over just to make sure I wrote it right. It's 2563062. That's the um member ID.
[AGENT][NEUTRAL] Yes.
[AGENT][POSITIVE] Yes, that's correct.
[CUSTOMER][NEUTRAL] No
[CUSTOMER][POSITIVE] Perfect. OK, thank you so much, [PII]. I hope you have a great day. Thank you for your help.
[AGENT][POSITIVE] OK, thank you for calling AP. You too. Bye-bye.
[CUSTOMER][NEUTRAL] bye.