AccountId: 011433970860
ContactId: 0d243782-7f5b-436e-8e65-6638e5295c91
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 175210 ms
Total Talk Time (AGENT): 83098 ms
Total Talk Time (CUSTOMER): 52892 ms
Interruptions: 0
Overall Sentiment: AGENT=2.7, CUSTOMER=0.8
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/04/18/0d243782-7f5b-436e-8e65-6638e5295c91_20250418T13:20_UTC.wav
--------------------------------------------
[AGENT][POSITIVE] Good morning. Thank you for calling APL. My name is [PII]. How may I help you?
[CUSTOMER][NEUTRAL] Hi, yes, I was calling to verify one of your members um benefits.
[AGENT][POSITIVE] OK, well, I'll be more than happy to assist you with the benefits. May I have your name and a good contact number in case we're disconnected?
[CUSTOMER][NEUTRAL] Yes, my name is [PII] and my contact number is [PII].
[AGENT][NEUTRAL] Thank you for that. And [PII], may I have the member's policy number?
[CUSTOMER][NEUTRAL] Yes, it's 02556451 ML8.
[AGENT][POSITIVE] Thank you for that hold on one moment.
[AGENT][NEUTRAL] And can you verify the member's first and last name and date of birth?
[CUSTOMER][NEUTRAL] Her name is [PII]. Date of birth is [PII].
[AGENT][NEUTRAL] Thank you for that and all the information provided is a verification of benefits, not a guarantee of payment. I am showing the policy is active. It's been effective since [PII]. And what type of benefits did you want to go over today?
[CUSTOMER][NEUTRAL] Um, so this patient is having an outpatient surgery in an ambulatory surgical center and is being left responsible for her deductible and a co-insurance. So I just wanted to know if you cover those charges after her primary insurance has, um, processed the claim and um what amount of benefits she has available.
[AGENT][NEUTRAL] OK. Um, so yes, we apply to the co-pay, deductible and co-insurance of covered charges after primary, um, for outpatient, we would pay up to $8700 per person per calendar year. There is no deductible.
[CUSTOMER][NEUTRAL] OK
[AGENT][NEUTRAL] And that does include surgery in a hospital outpatient facility or freestanding outpatient surgery center. Hold on one moment. I'm just gonna see if she's used any or how much she has for the year. Hold on one second.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][POSITIVE] OK, thank you.
[AGENT][POSITIVE] You're welcome.
[AGENT][NEUTRAL] So she's used $35 so she has $8,665 left for the year.
[CUSTOMER][NEUTRAL] Uh
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] All right, perfect. And can I have a reference number for this call?
[AGENT][NEUTRAL] So there's no call reference number, but you can use my name in today's date and again that's [PII].
[CUSTOMER][POSITIVE] OK, perfect. Thank you so much and I appreciate it.
[AGENT][POSITIVE] You're welcome and thanks for calling APLG, and I hope you have a great weekend.
[CUSTOMER][NEUTRAL] You too. Bye-bye.
[AGENT][POSITIVE] Thank you. Bye bye.