AccountId: 011433970860
ContactId: 0e907c74-6190-449e-9399-495309dcefc1
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 309929 ms
Total Talk Time (AGENT): 141299 ms
Total Talk Time (CUSTOMER): 87190 ms
Interruptions: 0
Overall Sentiment: AGENT=1.7, CUSTOMER=1.5
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/05/21/0e907c74-6190-449e-9399-495309dcefc1_20250521T12:19_UTC.wav
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[AGENT][NEUTRAL] Thank you for calling APL. This is [PII]. How can I help you?
[CUSTOMER][POSITIVE] Good morning how are you?
[AGENT][POSITIVE] I'm good. How are you?
[CUSTOMER][POSITIVE] Good, I'm calling to get benefits and eligibility for a member, please.
[AGENT][POSITIVE] Um, yes, ma'am. I can assist you with benefits. Um, first, can I get your name and a good callback number?
[CUSTOMER][NEUTRAL] Of course it's [PII].
[CUSTOMER][NEUTRAL] Nobody ask why are we gonna go out.
[CUSTOMER][NEUTRAL] Oh
[AGENT][POSITIVE] Thank you, [PII], and I need a good callback number just in case we're disconnected.
[CUSTOMER][NEUTRAL] Of course [PII].
[AGENT][NEUTRAL] Thank you. Now I need the policy number, please.
[CUSTOMER][NEUTRAL] Of course it's 017.
[CUSTOMER][NEUTRAL] 462.
[CUSTOMER][NEUTRAL] 07.
[AGENT][NEUTRAL] Thank you. Now, please verify the patient's name and date of birth.
[CUSTOMER][NEUTRAL] OK
[CUSTOMER][NEUTRAL] Of course it's [PII] and it's [PII].
[AGENT][NEUTRAL] Thank you and just let me advise you that verification of coverage does not guarantee payment of claims. Um, the effective date on this policy was [PII], and the policy is still active. Um, is this for inpatient or outpatient benefits or an office visit?
[CUSTOMER][NEUTRAL] It's an out uh outpatient it's office visit with a specialist and also a procedure would be done at the office.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] OK. Yes, ma'am. For services provided in office, um, we cover up to 1500 per calendar year, and that's for the co-insurance and the deductible after the primary insurance process is the claim, but co-pays for office visits is not covered.
[CUSTOMER][NEUTRAL] Oh
[CUSTOMER][NEGATIVE] Oh for office visit it's not covered.
[AGENT][NEUTRAL] Right, that's correct. But the procedures are, are covered up to 1500.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK, hold on, because I'm ready for sorry.
[CUSTOMER][NEUTRAL] And it's um 1500.
[CUSTOMER][NEUTRAL] Is per day or per calendar year?
[AGENT][NEUTRAL] Um, per calendar year and I'm showing that the full amount is available. None have been used so far this year.
[CUSTOMER][POSITIVE] OK perfect.
[CUSTOMER][POSITIVE] Perfect and I have another one. Would you be able to assist me with that one as well?
[AGENT][NEUTRAL] Um, yes, ma'am. One moment, please.
[CUSTOMER][POSITIVE] OK, thank you so much.
[AGENT][POSITIVE] No problem.
[AGENT][POSITIVE] OK, thanks for your patience. I'm ready for the next policy number.
[CUSTOMER][NEUTRAL] OK, the next one's 0183.
[CUSTOMER][NEUTRAL] 1585.
[CUSTOMER][NEUTRAL] Mm.
[AGENT][NEUTRAL] Thank you. Now, please verify the patient's name and date of birth.
[CUSTOMER][NEUTRAL] Of course it's [PII] and the date of birth is [PII].
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] OK, thank you and just let me advise you again that verification of coverage does not guarantee payment of claims. Um, he does have a new policy number.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] And his new policy number is
[AGENT][NEUTRAL] 024.
[AGENT][NEUTRAL] 56719.
[CUSTOMER][POSITIVE] Perfect thank you so much.
[AGENT][NEUTRAL] No problem. And the effective date on this policy was [PII] and the policy is still active. And would this be for also office treatments or services provided in office?
[CUSTOMER][NEUTRAL] Yes.
[CUSTOMER][NEUTRAL] Yeah.
[AGENT][NEUTRAL] OK, under this policy for office treatments, we cover up to $500 per day for the co-insurance and the deductible after the primary insurance processes the claim. But again, the office visit, um, the co-pay is not covered.
[CUSTOMER][NEUTRAL] OK, so you said 500 per day.
[AGENT][NEUTRAL] Yes, ma'am.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Oh it's up to 500 OK.
[CUSTOMER][NEUTRAL] OK, that was all. Can you provide me a reference for the card? I think you guys just used the date today's date, correct?
[AGENT][NEUTRAL] Um, you use my name and today's date. My name is [PII]. Um, it's spelled [PII] Last initial is [PII] and today's date. Um, is there anything else I can assist you with?
[CUSTOMER][POSITIVE] No, that was all. Thank you so much. You have a good day, OK?
[AGENT][NEUTRAL] You do the same, [PII]. Thank you for calling APL. Mm bye.
[CUSTOMER][POSITIVE] Thank you. Bye-bye.
[AGENT][POSITIVE] Thanks.