AccountId: 011433970860
ContactId: 03b72d4e-ef6b-45fc-a437-36635ec56ff1
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 168630 ms
Total Talk Time (AGENT): 84104 ms
Total Talk Time (CUSTOMER): 45990 ms
Interruptions: 1
Overall Sentiment: AGENT=0.8, CUSTOMER=0.9
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/03/07/03b72d4e-ef6b-45fc-a437-36635ec56ff1_20250307T19:29_UTC.wav
--------------------------------------------
[AGENT][NEUTRAL] Thank you for calling ATL. This is [PII]. How can I help you?
[CUSTOMER][NEUTRAL] Hi, [PII]. My name is [PII]. I'm calling from a provider's office. We just need help in checking eligibility and benefits of one of our patients' needs.
[AGENT][POSITIVE] Sure, I can check eligibility and benefits for you. Um, can I get a good call back number from you first in case we're disconnected?
[CUSTOMER][NEUTRAL] Uh yes, [PII].
[AGENT][NEUTRAL] Thank you. And then did you have that policy number?
[CUSTOMER][NEUTRAL] Um, I have here 01975791.
[AGENT][NEUTRAL] OK, and what was the name and date of birth for the insured?
[CUSTOMER][NEUTRAL] [PII]. Date of birth, [PII].
[AGENT][NEUTRAL] OK, thank you for verifying that information. uh, so this policy is active.
[AGENT][NEUTRAL] It was [PII], and this is a secondary medical policy, so it is designed to help with co-pay, deductible and co-insurance after major medical pays, and we're waiting to check the inpatient or outpatient benefits.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Um, for specialist office visit.
[AGENT][NEUTRAL] Office visit, OK, of course I will let you know verification of coverage is not a guarantee of payment for claims. So for this policy, office visits are not going to be covered. However, treatment received in office is and the outpatient benefit is $7000 max per calendar year.
[CUSTOMER][NEUTRAL] Mhm
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Um
[CUSTOMER][NEUTRAL] And nothing has met or there's a commodation?
[AGENT][NEUTRAL] Oh, I can see if anything has been met in one moment.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] OK, so she has used a bit of her outpatient benefit one moment.
[AGENT][NEUTRAL] OK, so she has used $340.18 of the outpatient benefits so far this year.
[CUSTOMER][NEUTRAL] Yeah
[CUSTOMER][NEUTRAL] Mm
[CUSTOMER][POSITIVE] Thank you so much. Can I have a reference number for this call, please?
[AGENT][NEUTRAL] Sure, reference number would just be my first name, last initial, and today's date. Uh so my name is spelled [PII] And was there anything else I can help you with?
[CUSTOMER][POSITIVE] Uh no, that's it. Thank you so much, [PII]. Have a great day. Bye for now.
[AGENT][POSITIVE] OK, yeah, thanks for calling APL you too bye bye.