AccountId: 011433970860
ContactId: 0debdde7-0aba-4fd0-a189-66d7c5cf8651
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 173250 ms
Total Talk Time (AGENT): 88586 ms
Total Talk Time (CUSTOMER): 47967 ms
Interruptions: 0
Overall Sentiment: AGENT=0.8, CUSTOMER=0.7
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/02/11/0debdde7-0aba-4fd0-a189-66d7c5cf8651_20250211T16:49_UTC.wav
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[AGENT][POSITIVE] Good morning. Thank you for calling APL. My name is [PII]. How may I help you?
[CUSTOMER][NEUTRAL] Hi [PII], um, I think I spoke to you earlier. I'm calling regarding a patient that I need to get benefits for a patient again.
[AGENT][POSITIVE] OK, and I'll be more than happy to help you with the benefits. May I have your name and a good contact number?
[CUSTOMER][NEUTRAL] My name is [PII]. Uh, phone number [PII].
[AGENT][NEUTRAL] Alright, and [PII], may I have the member's policy number?
[CUSTOMER][NEUTRAL] It's 02475386.
[AGENT][NEUTRAL] Thank you, hold on one moment.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] And can you verify the member's first and last name and date of birth?
[CUSTOMER][NEUTRAL] [PII] [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 that the policy is active, it's been effective since [PII].
[AGENT][NEUTRAL] And you need an outpatient benefit? Oh.
[CUSTOMER][POSITIVE] OK perfect and
[CUSTOMER][NEUTRAL] Yes, um, and can I have both outpatient and inpatient and also the, um, if this covers office visits?
[AGENT][NEUTRAL] OK, um, so we pay towards the copay, deductible and co-insurance of covered charges after primary.
[AGENT][NEUTRAL] For inpatient, the calendar year max is um $6000. 0, it's the same for inpatient and outpatient, um, it's $6000 for each per calendar year.
[AGENT][NEUTRAL] And let me see about the office visit.
[AGENT][NEUTRAL] Um, and treatment in the physician office is covered or should be covered under the policy up to that 6000 per year.
[CUSTOMER][NEUTRAL] But off the co-pays office visit copays are covered?
[AGENT][NEUTRAL] Yes, the co-pay, deductible and co-insurance. Now, if you charge for a facility charge,
[AGENT][NEUTRAL] Um, you know, like if you charge facility versus treatment, now the facility charges, um, most likely will not be covered under this policy. It's only the treatment in the office.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Got it OK and then um has he met anything on his.
[CUSTOMER][NEUTRAL] Um, for the 6000?
[AGENT][NEUTRAL] Let's see, hold on one moment.
[AGENT][NEGATIVE] Um, so far for this year, no, he has not used any of the benefits.
[CUSTOMER][NEUTRAL] OK perfect and uh and is there a reference number for this call?
[AGENT][NEUTRAL] So it'll be my name and today's date. Um, the first initial to my last name is [PII].
[CUSTOMER][POSITIVE] Perfect thank you so much and I appreciate it.
[AGENT][POSITIVE] You're welcome, [PII], and thanks for calling APL. I hope you have a great day.
[CUSTOMER][NEUTRAL] You too bye bye.
[AGENT][NEUTRAL] Bye-bye.