AccountId: 011433970860
ContactId: 0ec3e6ee-a7cb-42f6-8b84-4de92e9a2d4f
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 416579 ms
Total Talk Time (AGENT): 147262 ms
Total Talk Time (CUSTOMER): 146327 ms
Interruptions: 0
Overall Sentiment: AGENT=0.9, CUSTOMER=0.3
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/03/31/0ec3e6ee-a7cb-42f6-8b84-4de92e9a2d4f_20250331T18:03_UTC.wav
--------------------------------------------
[AGENT][NEUTRAL] Thank you for calling APL. This is [PII]. How can I help you?
[CUSTOMER][NEUTRAL] Uh, sorry, what's your name again?
[AGENT][NEUTRAL] Um, it's [PII]. Um it's spelled [PII] and my last initial is [PII].
[CUSTOMER][NEUTRAL] [PII]
[AGENT][NEUTRAL] Yes, ma'am.
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] Yes.
[CUSTOMER][NEUTRAL] Thank you. Um, uh, my name is [PII]. I'm calling from Doctor [PII]'s office. I would just like to get um benefit information for two of our patients.
[AGENT][POSITIVE] I'm sure I can assist you with benefits. Um, first, could I get a good callback number just in case we're disconnected?
[CUSTOMER][NEUTRAL] Sure. [PII].
[AGENT][NEUTRAL] Thank you. Now, I need the first policy number, please.
[CUSTOMER][NEUTRAL] Policy number is 023429948.
[AGENT][NEUTRAL] Thank you. Now, please verify the patient's name and date of birth.
[CUSTOMER][NEUTRAL] Um, [PII], [PII].
[AGENT][NEUTRAL] 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] OK.
[CUSTOMER][NEUTRAL] Outpatient, outpatient office visit, specialist office visit.
[AGENT][NEUTRAL] Yes, ma'am, for services provided in office, we cover up to $500 per day, and that's for the coinsurance and the deductible after the primary insurance processes the claim, but the um charge for the co-pay is not covered.
[CUSTOMER][NEUTRAL] What's the
[CUSTOMER][NEUTRAL] Accumulation for the outpatient benefit maximum.
[AGENT][NEUTRAL] Well, it's 500 per day.
[CUSTOMER][NEUTRAL] Uh, OK, got it.
[AGENT][NEUTRAL] Yes, ma'am.
[CUSTOMER][NEUTRAL] So office visit is not covered.
[AGENT][NEUTRAL] Right, the co-pay for.
[CUSTOMER][NEUTRAL] There's just an outpatient benefit.
[AGENT][NEUTRAL] Yes, ma'am. For office treatments, there's only coverage for that, that goes towards the co-insurance and the deductible, but the co-pay for the visit is not covered.
[CUSTOMER][NEGATIVE] Not covered.
[CUSTOMER][NEUTRAL] March.
[CUSTOMER][NEUTRAL] What's the reference number for this call?
[AGENT][NEUTRAL] Um, for the reference number, you can use my name and today's date.
[CUSTOMER][NEUTRAL] Oh, got it.
[CUSTOMER][NEUTRAL] I have another patient.
[AGENT][NEUTRAL] OK, one moment, please.
[CUSTOMER][NEUTRAL] Um, before we move on to the next patient for your [PII], is there like a group number?
[AGENT][NEUTRAL] Sure.
[AGENT][NEUTRAL] Um, yes, ma'am. The group number is.
[AGENT][NEUTRAL] Group number is 15035.
[CUSTOMER][NEUTRAL] And also [PII] is the spouse or she's a dependent. Can I have the date of birth of the primary policy holder, which is [PII] because I don't have his date of birth. Can I have it?
[AGENT][NEUTRAL] I'm sorry, we can't give out that information.
[CUSTOMER][POSITIVE] Uh, got it. I totally understand.
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Mm.
[CUSTOMER][NEUTRAL] All right.
[CUSTOMER][NEUTRAL] I can move on now to the next patient if just tell me whenever you're ready.
[AGENT][POSITIVE] I'm ready.
[CUSTOMER][NEUTRAL] Um
[CUSTOMER][NEUTRAL] For the next patient, [PII].
[CUSTOMER][NEUTRAL] Um.
[CUSTOMER][NEUTRAL] The certificate or member ID is 02467711.
[AGENT][NEUTRAL] OK, please repeat that number.
[CUSTOMER][NEUTRAL] Hold on. 02467711.
[AGENT][NEUTRAL] Thank you. Now, please verify the patient's name and date of birth.
[CUSTOMER][NEUTRAL] [PII], [PII].
[AGENT][NEUTRAL] OK. Thank you. And again, just advise you the verification of coverage does not guarantee payment of claims. The effective date on this policy was [PII] and the policy is still active. And is this for the same benefit for services provided in office?
[CUSTOMER][NEUTRAL] Got it.
[AGENT][NEUTRAL] OK. Yes, ma'am. Under this policy, we cover up to 8500 per calendar year and that's also for the co-pay, I'm sorry, for the co-insurance and the deductible after the primary insurance and the co-pay is not covered.
[CUSTOMER][NEUTRAL] So the office visit copay is still not covered.
[AGENT][POSITIVE] Yes, ma'am. That's correct.
[CUSTOMER][NEUTRAL] Um
[CUSTOMER][NEUTRAL] Um, if it's
[CUSTOMER][NEUTRAL] Uh, what's the accumulation for the
[CUSTOMER][NEUTRAL] 8500.
[AGENT][NEUTRAL] Let's see.
[AGENT][NEUTRAL] Um, nothing has been used, so the full 8500 is available.
[CUSTOMER][NEUTRAL] Uh
[CUSTOMER][NEUTRAL] The dream.
[CUSTOMER][NEUTRAL] Same reference number, right? Your name and today's date.
[AGENT][POSITIVE] Yes, ma'am. That's correct. Do you also need the group number for this one?
[CUSTOMER][NEUTRAL] Uh
[CUSTOMER][POSITIVE] Uh, no need. That's all for me for today. Thank you so much, [PII].
[AGENT][POSITIVE] OK. Well, since there isn't anything else I can assist you with, [PII] thank you for calling APL. You have a great rest of your day. Bye.
[CUSTOMER][POSITIVE] You too. Take care. Bye-bye.
[AGENT][NEUTRAL] OK.