AccountId: 011433970860
ContactId: 087fd3eb-73bd-420f-b1f9-e99c5556792b
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 188089 ms
Total Talk Time (AGENT): 118939 ms
Total Talk Time (CUSTOMER): 55900 ms
Interruptions: 1
Overall Sentiment: AGENT=2.1, CUSTOMER=0.6
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/02/26/087fd3eb-73bd-420f-b1f9-e99c5556792b_20250226T15:29_UTC.wav
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[AGENT][POSITIVE] Good morning. Thank you for calling APL. This is [PII]. How may I help you today?
[CUSTOMER][NEUTRAL] Yes, I'm calling to get benefits for a patient. She needs to have a uh surgical procedure done in the office.
[AGENT][POSITIVE] OK, I'll be glad to help you. Go and give me your name and that member's policy number, please.
[CUSTOMER][NEUTRAL] My name is [PII].
[CUSTOMER][NEUTRAL] And the policy number 01670155 M like Mary L like Larry 8.
[AGENT][POSITIVE] Alright, thank you so much for that information, [PII]. Now while I'm pulling this up, go ahead and give me a good return telephone call number, please.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] [PII].
[CUSTOMER][NEUTRAL] Yeah
[AGENT][NEUTRAL] All right, thank you so much, [PII]. Now your patient's name and date of birth.
[CUSTOMER][NEUTRAL] [PII] date of birth [PII].
[AGENT][NEUTRAL] Alrighty, thank you so much, [PII], for that information. It looks like [PII] is the insured on this medical supplemental plan. I do show her original effective date is [PII]. She is current and active, but I must advise that verification of coverage is not a guarantee of payment on a claim, but you did say you want some type of benefit. Is that correct?
[CUSTOMER][NEUTRAL] Yes
[CUSTOMER][NEUTRAL] Yes, she's having a surgical procedure done in the office.
[AGENT][NEUTRAL] Alrighty, let's see. Do you know what she's having done?
[CUSTOMER][NEUTRAL] Yes, she's having a hysteroscopy. I have a procedure code.
[AGENT][NEUTRAL] Oh, that's OK. Alrighty, let's see what her benefits are. OK, now what we are, of course, [PII] is her medical supplemental plan. So the only thing that we would pick up and pay on is anything that is applied towards her deductible, co-pay, or co-insurance at her primary insurance carrier, and we only pay for sickness and injury only. Nothing routine here is covered no matter what.
[AGENT][NEUTRAL] Now her outpatient benefit here or anything done in the doctor's office, um, she does not have the office visit charge benefit here, but anything done in the office would be no pre-cert. She has no deductible, and she has a benefit of $6800 payable per calendar year.
[CUSTOMER][NEUTRAL] OK and has she met anything of that so far?
[AGENT][NEUTRAL] Let's see.
[CUSTOMER][NEUTRAL] So
[AGENT][NEUTRAL] Um
[AGENT][NEUTRAL] As of today, she's not used any of her [PII] benefit. No, ma'am, that's as of today.
[CUSTOMER][POSITIVE] OK awesome and what was your name again? I'm sorry?
[AGENT][NEUTRAL] My name is [PII]. That's [PII] And is that all that I can answer for you today, [PII]?
[CUSTOMER][NEUTRAL] Yes, can I please have a reference number?
[AGENT][NEUTRAL] Do not give reference numbers, but you can use my name in today's date, [PII], OK?
[CUSTOMER][POSITIVE] OK, thank you so much. Have a good day.
[AGENT][POSITIVE] Yes, ma'am. You as well, [PII]. Thanks for calling APL. Bye-bye.
[CUSTOMER][NEUTRAL] Bye.