AccountId: 011433970860
ContactId: 0f03d4e7-ab22-4ca1-aae2-b59581af99ee
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 213320 ms
Total Talk Time (AGENT): 104988 ms
Total Talk Time (CUSTOMER): 53388 ms
Interruptions: 0
Overall Sentiment: AGENT=1.3, CUSTOMER=0.3
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/04/07/0f03d4e7-ab22-4ca1-aae2-b59581af99ee_20250407T14:09_UTC.wav
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[AGENT][NEUTRAL] Good morning. Thank you for calling APL. This is [PII]. How may I assist you?
[CUSTOMER][NEUTRAL] Hi, so, this is [PII] with Ainia Healthcare. I'm calling to check uh general uh benefit information for a patient.
[AGENT][POSITIVE] OK, sure, I can assist you with benefit and eligibility. And may I have a callback number just in case we get disconnected?
[CUSTOMER][NEUTRAL] Yes, direct line is [PII].
[AGENT][NEUTRAL] OK, thank you. And may I have the patient's policy number?
[CUSTOMER][NEUTRAL] I am showing 0226743 02267453.
[AGENT][POSITIVE] OK, thank you.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] May I have the name and date of birth of the patient?
[CUSTOMER][NEUTRAL] G G Street, [PII].
[AGENT][POSITIVE] All right, thank you.
[AGENT][NEUTRAL] And what type of service is being rendered for benefits?
[CUSTOMER][NEUTRAL] Uh, I'm checking, um, the co-payment that's due for office visits, specialist visits, um, urgent care visit, and vision.
[CUSTOMER][NEUTRAL] If it if it's covered.
[AGENT][NEUTRAL] OK. Vision is not covered unless it's like a medical procedure, um, but if it's regular um vision is not covered. OK, um, let me go ahead and
[CUSTOMER][NEUTRAL] If the routine.
[AGENT][NEUTRAL] Yeah, routine is not covered, dental, vision or pharmacy is not covered. OK. Uh, this is one of our secondary supplemental plans for the major medical.
[CUSTOMER][NEUTRAL] When you said
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] And let me go ahead and tell you that this is not a guaranteed payment, just a verification of coverage and that's just a disclaimer. And let's see if it covers the co-payment.
[AGENT][NEUTRAL] OK, so this one does not cover the office visit itself. It only covers treatments or procedures done in the office, and that is subject to the outpatient maximum which is 6000 per cover person per calendar year.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] And uh what's the accumulative?
[AGENT][NEUTRAL] OK, let me check on that, one moment.
[AGENT][NEUTRAL] All right, so as of today, she has not used her benefits for [PII], so she still have the full amount available.
[CUSTOMER][NEUTRAL] OK, and is there a reference call number for today?
[AGENT][NEUTRAL] We don't have reference numbers, Ms. [PII]. You can use my name and today's date if you will. Do you need the spelling of my name or any other information?
[CUSTOMER][NEUTRAL] Yes, please.
[AGENT][NEUTRAL] OK, the spelling of my name is [PII].
[CUSTOMER][POSITIVE] OK, thank you for that so you have a great week.
[AGENT][POSITIVE] You're welcome. You as well, Mr. [PII] and thank you for calling [PII]. Bye-bye.