AccountId: 011433970860
ContactId: 0daf396c-878f-4f4f-a8de-ec1bbbe15777
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 164839 ms
Total Talk Time (AGENT): 93800 ms
Total Talk Time (CUSTOMER): 61865 ms
Interruptions: 1
Overall Sentiment: AGENT=0.8, CUSTOMER=1.9
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/01/03/0daf396c-878f-4f4f-a8de-ec1bbbe15777_20250103T18:13_UTC.wav
--------------------------------------------
[AGENT][NEUTRAL] Good afternoon. Thank you for calling APL. This is [PII]. How may I assist you?
[CUSTOMER][NEUTRAL] Hi, good afternoon, my name is [PII]. I'm calling from the physician office to verify your patient's benefits.
[AGENT][POSITIVE] OK, sure. I can assist you with benefits, Miss [PII]. May I have a callback number just in case we get disconnected?
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] OK. And may I have the patient's policy number?
[CUSTOMER][NEUTRAL] Policy number is 02030186ML8.
[AGENT][NEUTRAL] Yeah
[CUSTOMER][NEUTRAL] In the
[CUSTOMER][NEUTRAL] the.
[AGENT][NEUTRAL] And may I have the name and date of birth of the patient?
[CUSTOMER][NEUTRAL] Uh [PII] [PII].
[AGENT][NEUTRAL] OK, thank you. And what type of service is being render for benefits?
[CUSTOMER][NEUTRAL] Uh, like everything done in office, like a specialist office visit, in office ultrasound, and in surgical procedure done in office as well.
[AGENT][NEUTRAL] OK. All right. And before I give you any benefit information, I need to let you know that this is not a guarantee of payment, just a verification of coverage, and that's just a disclaimer.
[AGENT][NEUTRAL] And let's see with this one, let me see what we do in office.
[CUSTOMER][NEUTRAL] So that I know.
[AGENT][NEUTRAL] Mm OK. So it looks like we do cover the office treatments or procedures. We do not cover the office visit itself. Um, the office, um, procedures or treatments are subject to the outpatient maximum which is 2500 per covered person per calendar year. And again, this is not a guarantee of payment, just a verification of coverage.
[CUSTOMER][POSITIVE] Perfect, um, I'm sorry, how about for inpatient?
[AGENT][NEUTRAL] Inpatient, if she goes to a hospital and she needs to stay 18 hours or more, that is gonna be considered inpatient and that is 4000 per cover person per calendar year.
[CUSTOMER][POSITIVE] Alright perfect thank you so much. I think that would be all I'm sorry, the set of day for this plan when is it?
[AGENT][NEUTRAL] Mhm
[AGENT][NEUTRAL] OK, let me get that for you one moment.
[AGENT][NEUTRAL] and that is effective [PII]. For her, it's going to be [PII] for [PII].
[CUSTOMER][NEUTRAL] [PII]. OK, good, thank you, perfect. Um, so yeah, that would be all uh there is any reference number or your name?
[AGENT][NEUTRAL] So it's [PII]. Mhm.
[AGENT][NEUTRAL] Mhm.
[AGENT][POSITIVE] You're welcome.
[AGENT][NEUTRAL] Yeah
[AGENT][NEUTRAL] My name in today's date, we don't have reference numbers.
[CUSTOMER][POSITIVE] Perfect and your niece I'm sorry?
[AGENT][NEUTRAL] My name is [PII], that's [PII].
[CUSTOMER][POSITIVE] Thank you so much have a nice day.
[AGENT][POSITIVE] You as well. Thank you for calling APM. Bye-bye, Miss [PII].
[CUSTOMER][NEUTRAL] Bye.