AccountId: 011433970860
ContactId: 05397c03-8673-4011-8e32-b6d06c0fba87
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 203039 ms
Total Talk Time (AGENT): 94085 ms
Total Talk Time (CUSTOMER): 105988 ms
Interruptions: 6
Overall Sentiment: AGENT=2, CUSTOMER=0.9
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/05/27/05397c03-8673-4011-8e32-b6d06c0fba87_20250527T19:19_UTC.wav
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[AGENT][NEUTRAL] Thank you for calling APL. This is [PII]. How can I help you?
[CUSTOMER][NEUTRAL] Hi, [PII]. My name is [PII]. It's [PII] and the initial is [PII]. How are you doing today?
[AGENT][POSITIVE] I'm doing well [PII] how are you?
[CUSTOMER][POSITIVE] I'm doing well. Thank you so much for asking. My concern is regarding the eligibility and benefits for the patient.
[AGENT][NEUTRAL] OK, I could check eligibility and benefits for you. Um, before we go any further, can I get a good call back number from you in case we're disconnected please?
[CUSTOMER][NEUTRAL] Yeah
[CUSTOMER][NEUTRAL] Yeah, the callback number is [PII] and I have an extension of [PII].
[AGENT][NEUTRAL] Thank you and then do you have that policy number?
[CUSTOMER][NEUTRAL] Uh yeah, I have the outpatient benefit er number. It is 02574984 M as in Mike, L as in Larry, 8.
[AGENT][NEUTRAL] OK and then what was the name and date of birth for the member please?
[CUSTOMER][NEUTRAL] Member's name is [PII] and their date of birth is [PII].
[AGENT][NEUTRAL] OK thank you so much for verifying that. uh, so this policy is active effective date was [PII].
[CUSTOMER][NEUTRAL] Yeah
[CUSTOMER][NEUTRAL] What's that?
[CUSTOMER][NEUTRAL] Yeah.
[AGENT][NEUTRAL] 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 really need to look at inpatient or outpatient benefits for this member tenure.
[CUSTOMER][NEUTRAL] Yeah
[CUSTOMER][NEUTRAL] Well, I didn't
[CUSTOMER][NEUTRAL] That.
[CUSTOMER][NEUTRAL] Outpatient should be done in the doctor's office for specialist office visit.
[AGENT][NEUTRAL] OK. Of course. Oh, OK.
[AGENT][NEUTRAL] Office visit OK and of course I will let you know verification of coverage is not a guarantee of payment for claims. So under this policy office visits are not going to be covered. However, treatment received in office is covered under their outpatient benefit that benefit amount is $2500 per calendar year.
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] I don't know about that.
[CUSTOMER][NEUTRAL] You
[CUSTOMER][NEUTRAL] Yeah yeah.
[CUSTOMER][NEUTRAL] OK. So the specialist office visit services are not covered, but office procedures are covered. Is that correct?
[AGENT][NEUTRAL] Treatment received in office is, yes, but the visit itself is not covered.
[CUSTOMER][NEUTRAL] OK, so this case, so the specialist visit is not covered, but the treatment is covered. I mean, like any procedure or injections are covered.
[AGENT][POSITIVE] Correct. If there were treatment received. That's correct.
[CUSTOMER][NEUTRAL] OK. And you said that the maximum limit is 35, 3500. Is that correct?
[AGENT][NEUTRAL] Uh, 2500 per calendar year.
[CUSTOMER][NEUTRAL] OK. And is there any me amount for that?
[AGENT][NEUTRAL] Was there what? I'm sorry?
[CUSTOMER][NEUTRAL] Yeah. Uh, the treatments are covered up to $2500. Is that correct?
[AGENT][POSITIVE] That's correct.
[AGENT][POSITIVE] Yes, that's correct.
[CUSTOMER][POSITIVE] OK, thank you so much. And could you please spell out your name for me?
[AGENT][POSITIVE] Oh sure, it's [PII] was there anything else I can help you with?
[CUSTOMER][NEUTRAL] And
[CUSTOMER][NEUTRAL] Uh, now, may I get the initial to your last name?
[AGENT][NEUTRAL] Last initial is A.
[CUSTOMER][POSITIVE] Thank you. And I'm ready for your reference number whenever you are.
[AGENT][NEUTRAL] Sure, reference number would just be my first name, last initial and today's date.
[CUSTOMER][POSITIVE] Thank you so much [PII] for assisting me. Have a great day. Thank you. Bye bye.
[AGENT][POSITIVE] Of course, thanks for calling APL you too thank you bye bye.