AccountId: 011433970860
ContactId: 02ed8adc-f21b-4947-80e5-0cb018811cd0
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 276390 ms
Total Talk Time (AGENT): 107101 ms
Total Talk Time (CUSTOMER): 110170 ms
Interruptions: 2
Overall Sentiment: AGENT=0.9, CUSTOMER=0.1
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/05/30/02ed8adc-f21b-4947-80e5-0cb018811cd0_20250530T20:53_UTC.wav
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[AGENT][NEUTRAL] Yeah.
[AGENT][NEUTRAL] Thank you for calling APL. This is [PII]. How can I help you?
[CUSTOMER][NEUTRAL] Hello, um, I'm calling from the Constitution's urgent care, and I wanted to see the eligibility and the benefits of a patient.
[AGENT][POSITIVE] Sure, I can help you with eligibility and benefits. Can I get your name and a good callback number in case we get disconnected?
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Yeah, it's um [PII] and my name is [PII].
[CUSTOMER][NEUTRAL] This
[AGENT][NEUTRAL] And what's the policy number?
[CUSTOMER][NEUTRAL] Um, the policy number is 02581906.
[AGENT][NEUTRAL] OK, give me just a moment.
[CUSTOMER][NEUTRAL] But it
[CUSTOMER][NEUTRAL] Right.
[CUSTOMER][NEUTRAL] That
[CUSTOMER][POSITIVE] But she still an effective date to right the effective date.
[CUSTOMER][NEUTRAL] And the copay and the reference number, those are the three things that I look at.
[CUSTOMER][NEUTRAL] No, I can't find the.
[AGENT][NEUTRAL] I'm sorry, I have 02.
[AGENT][NEUTRAL] 58
[AGENT][NEUTRAL] 1906, correct?
[CUSTOMER][NEUTRAL] Mm
[CUSTOMER][POSITIVE] Yes correct.
[AGENT][NEUTRAL] OK, give me just a moment.
[CUSTOMER][NEUTRAL] The school called her she said she didn't see the call for.
[AGENT][NEUTRAL] Can you verify the patient's name and date of birth, please?
[CUSTOMER][NEUTRAL] Yeah, it's uh [PII] and her date of birth is [PII].
[AGENT][POSITIVE] OK, thank you so much.
[CUSTOMER][NEUTRAL] That's
[CUSTOMER][NEUTRAL] The injuries happen up too, especially now.
[AGENT][NEUTRAL] OK, I'm showing that this policy is active with an effective date of [PII].
[CUSTOMER][NEUTRAL] I know.
[CUSTOMER][NEUTRAL] here
[CUSTOMER][NEGATIVE] Oh shit.
[AGENT][NEUTRAL] This is a meddling policy, so it is secondary gap insurance. We will need the primary um explanation of benefits and filing a claim under this policy.
[CUSTOMER][NEUTRAL] 8
[AGENT][NEUTRAL] And were there specific benefits you were needing?
[CUSTOMER][NEUTRAL] Uh, for urgent, uh, yeah, for urgent care if they have a copay.
[AGENT][NEUTRAL] You had questions on?
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Yes.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] I
[CUSTOMER][NEGATIVE] I don't like that.
[CUSTOMER][NEUTRAL] Everybody
[CUSTOMER][NEUTRAL] I
[AGENT][NEUTRAL] Right, and this is just a verification of benefits, not a guarantee of payment. It looks like we have an outpatient benefit maximum of up to $2000 per covered person per calendar year with a $6000 maximum.
[CUSTOMER][NEUTRAL] I'm gonna be a.
[AGENT][NEUTRAL] Um,
[AGENT][NEUTRAL] In order for services to be covered, uh, it will need to be due to a sickness or accident and again this is secondary gap, so we will need to have the primary showing that they paid partial or all benefits, um, when filing a claim for this.
[CUSTOMER][NEUTRAL] Yes.
[CUSTOMER][NEUTRAL] But
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] But they do have urgent care.
[CUSTOMER][NEUTRAL] What is there a copayment? So there's no co-payment.
[AGENT][POSITIVE] Correct. This helps cover co-payment, uh, insurance, and co-deductible.
[CUSTOMER][NEUTRAL] OK, OK, I a call reference number. OK, and then I just need a callback reference number please.
[AGENT][NEUTRAL] OK, so we don't have call reference numbers, but you can use my name and last initial in today's date. So [PII] and then today's date.
[CUSTOMER][NEUTRAL] Mhm
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][POSITIVE] OK. All right. Perfect, [PII]. Thank you so much.
[AGENT][POSITIVE] OK. Thank you for calling APL. I hope you have a great day.
[CUSTOMER][NEUTRAL] You as well.