AccountId: 011433970860
ContactId: 033a15fc-d2ed-49a5-9703-4111f0421779
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 367839 ms
Total Talk Time (AGENT): 137053 ms
Total Talk Time (CUSTOMER): 93751 ms
Interruptions: 0
Overall Sentiment: AGENT=0, CUSTOMER=0.2
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/01/16/033a15fc-d2ed-49a5-9703-4111f0421779_20250116T21:11_UTC.wav
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[AGENT][POSITIVE] Good Afternoon. Thanks for calling Eli [PII]. How can I help you?
[CUSTOMER][NEUTRAL] Um, hi, um, my name is [PII]. I am calling with Desert Orthopedic Center, and I was calling to see if, um, to get this patient's eligibility and benefits.
[AGENT][NEUTRAL] OK, I can help you with that. And you said your name is [PII]?
[CUSTOMER][NEUTRAL] [PII]
[AGENT][NEUTRAL] OK, and can I get a callback number just in case we get disconnected?
[CUSTOMER][NEUTRAL] Yes, it's [PII].
[AGENT][NEUTRAL] The policy number?
[CUSTOMER][NEUTRAL] It is 0, let me look at the card to double check, 0256509.
[AGENT][NEGATIVE] There's a number missing somewhere.
[CUSTOMER][NEUTRAL] Let me double check. So on here it has 02565109, that's what's on the card.
[AGENT][NEUTRAL] Yes.
[AGENT][NEUTRAL] The member's name, date of birth.
[CUSTOMER][NEUTRAL] It is [PII]. Date of birth is, let me scroll up, [PII].
[AGENT][NEUTRAL] OK, [PII], thank you for that. You said you want an eligibility and benefits?
[CUSTOMER][NEUTRAL] Yes, sir, ma'am.
[AGENT][NEUTRAL] This for a doctor's visit?
[CUSTOMER][NEUTRAL] Sorry.
[CUSTOMER][NEUTRAL] Um, yes, ma'am, a specialist office visit.
[AGENT][NEUTRAL] OK, give me 1 2nd please.
[AGENT][NEUTRAL] Oh
[AGENT][NEUTRAL] Let's see.
[AGENT][NEUTRAL] Tre the same uh.
[AGENT][NEUTRAL] Uh
[AGENT][NEUTRAL] Um,
[AGENT][NEUTRAL] OK I'm showing the policy is active as of [PII].
[AGENT][NEUTRAL] I am just trying to see what benefit he has in the office, so give me.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] Uh
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] OK. Is it for just a regular doctor's visit or is he gonna be having services done in the doctor's office?
[CUSTOMER][NEUTRAL] A specialist office visit, so maybe general information like um well, maybe he's getting a diagnostic X-ray, a DME or um
[CUSTOMER][NEUTRAL] Either of those.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] So as far as a regular office visit, um, and it's not covered, but as far as any services that are done, um,
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] So, he has coverage for surgery.
[AGENT][NEUTRAL] In the office.
[AGENT][NEUTRAL] Um, diagnostic testing is covered.
[AGENT][NEUTRAL] Let me see.
[AGENT][NEUTRAL] And it does cover for DME. It just, um, varies on what type of DMEs it is. So let me see what the coverage will be like.
[AGENT][NEUTRAL] Mhm.
[AGENT][NEUTRAL] And they pay up to a maximum of 3000 per calendar year.
[CUSTOMER][NEUTRAL] They pay up to 3000.
[AGENT][NEUTRAL] From calendar year.
[CUSTOMER][NEUTRAL] For calendar year?
[AGENT][NEUTRAL] Yes ma'am.
[CUSTOMER][NEUTRAL] And which one is that? So is it the office visit or like X-ray?
[AGENT][NEGATIVE] Well, it doesn't pay for an actual office visit. It only pays for like the services that are done.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] So he would have to pay the office visit, um, whatever his, whatever his primary, um, applies to his out of pocket, he would have to pay that for the office visit.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] And then it covers any, let's see.
[AGENT][NEUTRAL] Any like type of services like it, um, depending on what type of testing it gets done. I said so it's kinda hard to tell you. So it depends on what kind of testing he gets done or or surgery or DME um falls up under that.
[CUSTOMER][NEUTRAL] OK, and um, did they, did he use any of the 3000?
[AGENT][NEUTRAL] No, ma'am, he hasn't had any claims submitted uh for this year.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] All right, may I get a reference number please?
[AGENT][NEUTRAL] We don't give reference numbers you can use my name in today's date.
[CUSTOMER][NEUTRAL] OK. Can you spell your name for me, please?
[AGENT][NEUTRAL] It's [PII]
[CUSTOMER][NEUTRAL] Alright.
[CUSTOMER][POSITIVE] Thank you so much you've been very helpful.
[AGENT][NEUTRAL] I'm [PII], was there anything else that I can help you with today?
[CUSTOMER][NEUTRAL] No ma'am, that was it.
[AGENT][POSITIVE] Alright, well thanks for calling AL. You have a wonderful day.
[CUSTOMER][NEUTRAL] You too bye.
[AGENT][NEUTRAL] Uh-huh, bye.