AccountId: 011433970860
ContactId: 0256eadd-0fcf-4e14-94a6-818da6def682
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 283279 ms
Total Talk Time (AGENT): 113843 ms
Total Talk Time (CUSTOMER): 82495 ms
Interruptions: 0
Overall Sentiment: AGENT=1, CUSTOMER=0.8
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/04/21/0256eadd-0fcf-4e14-94a6-818da6def682_20250421T15:51_UTC.wav
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[CUSTOMER][NEUTRAL] I again to make sure it's active.
[AGENT][POSITIVE] Good morning. Thank you for calling APL. My name is [PII]. How may I help you?
[CUSTOMER][NEUTRAL] Hey, good morning, [PII]. My name is [PII]. How are you today?
[AGENT][POSITIVE] I'm doing well. How are you?
[CUSTOMER][POSITIVE] I'm doing good as well. I wanted to verify patient's eligibility, please.
[AGENT][NEUTRAL] OK, well, I can definitely help you with the eligibility and may I have a good contact number in case we're disconnected and the member's policy number?
[CUSTOMER][NEUTRAL] Yes, it's [PII].
[CUSTOMER][NEUTRAL] And the member ID number is 02607909.
[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] [PII], date of birth is [PII].
[AGENT][NEUTRAL] Thank you for that and all the information provided is a verification of benefits, not a guarantee of payment, and I am showing that the policy is active. It's been effective since [PII].
[CUSTOMER][NEUTRAL] And
[CUSTOMER][NEUTRAL] you know history as well.
[AGENT][NEGATIVE] Alright, hold on one moment because the phone went in and out. I didn't hear anything you said. It was very choppy.
[CUSTOMER][NEUTRAL] OK. Um, I was asking if she had any history?
[CUSTOMER][NEUTRAL] And she still had her 500?
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Available?
[AGENT][NEUTRAL] Um, so let me try it this way. So there's no history on file and
[AGENT][NEUTRAL] She, there's no history, so they haven't used any of the benefits.
[CUSTOMER][NEUTRAL] And then her deductible is $50 150 dollars for family.
[AGENT][POSITIVE] Yes, that's correct.
[CUSTOMER][NEUTRAL] And then there's still no major coverage, correct?
[AGENT][NEUTRAL] Right, this policy only covers preventative, radiograph, FMX, and basic.
[CUSTOMER][NEUTRAL] OK, and then uh for the 0210 is it covered at 100 or 80?
[AGENT][NEUTRAL] Um, hold on one moment, let me get the fax back. You said 0210?
[CUSTOMER][NEUTRAL] Yes.
[AGENT][NEUTRAL] 0210. Hold on one moment.
[AGENT][NEUTRAL] 00
[AGENT][NEUTRAL] 210 is under radiograph SMX, so that's 80%.
[CUSTOMER][NEUTRAL] OK, PA 0220 are also under 80%.
[AGENT][NEUTRAL] Hold on one second, 0220, yes, that's correct.
[CUSTOMER][NEUTRAL] OK, and filling the 2392 those are covered at 80%?
[AGENT][NEUTRAL] 2392, hold on one second. 92, yes.
[CUSTOMER][NEUTRAL] OK. Um, is 4341 a covered benefit?
[AGENT][NEUTRAL] No, that's major.
[CUSTOMER][NEUTRAL] OK. And what about 4910?
[AGENT][NEUTRAL] I believe that's major too, but let me double check. Hold on one second.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Right.
[AGENT][NEUTRAL] Yes, 4910 is major as well. That's not on this fax back.
[CUSTOMER][POSITIVE] OK, awesome thank you so much, [PII]. Can I please 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. The first initial to my last name is [PII].
[CUSTOMER][NEUTRAL] Hey, before I let you go, um,
[CUSTOMER][NEUTRAL] Is our doctor in network?
[AGENT][NEUTRAL] Um, so this policy is on the Carrington PPO network. However, the benefits are the same whether you're a Carrington provider or not. Um, we do not have access to Carrington's list of providers, but I can give you their phone number if you would like to check and see if your provider is Carrington.
[CUSTOMER][NEUTRAL] OK. Go ahead.
[AGENT][NEUTRAL] Hold on one moment.
[AGENT][NEUTRAL] The phone number is [PII].
[CUSTOMER][NEUTRAL] OK
[AGENT][NEUTRAL] [PII].
[AGENT][NEUTRAL] [PII].
[CUSTOMER][POSITIVE] Awesome. Thank you so much and I hope you have a great day.
[AGENT][POSITIVE] You're very welcome, [PII]. Was there anything else I can help with?
[CUSTOMER][POSITIVE] No, that would be it. Thank you.
[AGENT][POSITIVE] Alright, thanks for calling APL bye bye.
[CUSTOMER][NEUTRAL] Mhm bye bye.
[CUSTOMER][NEUTRAL] Yeah.