AccountId: 011433970860
ContactId: 16743a2f-f117-405e-bace-655f2960ecff
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 202130 ms
Total Talk Time (AGENT): 84016 ms
Total Talk Time (CUSTOMER): 69075 ms
Interruptions: 1
Overall Sentiment: AGENT=2.7, CUSTOMER=0.2
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/01/21/16743a2f-f117-405e-bace-655f2960ecff_20250121T13:36_UTC.wav
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[AGENT][POSITIVE] Morning, thank you for calling APL. My name is [PII]. How may I help you?
[CUSTOMER][NEUTRAL] Hi [PII], I'm trying to verify benefits eligibility and benefits on a member please.
[AGENT][POSITIVE] It would be my pleasure to assist you. May I ask your name?
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] Thank you, [PII], and the callback number?
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] And [PII], what is the policy number for the patient, please?
[CUSTOMER][NEUTRAL] 02493162.
[AGENT][NEUTRAL] Thank you, [PII] and the patient's name and date of birth, please?
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] Date of birth?
[CUSTOMER][NEUTRAL] Um, give me one second, hold on.
[CUSTOMER][NEUTRAL] [PII] [PII].
[CUSTOMER][NEUTRAL] I mean, I'm sorry.
[CUSTOMER][NEUTRAL] Um, hold on, sorry.
[AGENT][POSITIVE] Take your time, it's fine.
[CUSTOMER][NEUTRAL] 37.
[CUSTOMER][NEUTRAL] 71.
[AGENT][POSITIVE] OK, thank you, [PII], and it would be my pleasure to assist you with eligibility and benefits for [PII].
[CUSTOMER][NEUTRAL] Mm
[AGENT][NEUTRAL] I'm showing her policy is active.
[AGENT][NEUTRAL] Effective date is [PII].
[AGENT][NEUTRAL] This is a secondary policy to her major medical coverage.
[AGENT][NEUTRAL] And are there specific benefits you're needing?
[CUSTOMER][NEUTRAL] Um, yes, I need coverage. Um, she has, um, I believe, co-insurance responsibilities.
[CUSTOMER][NEUTRAL] Um, and I needed to know exactly what this policy covers under medical.
[AGENT][NEUTRAL] Is it for an office visit or outpatient procedure?
[CUSTOMER][NEUTRAL] Office visit, diagnostic testing.
[AGENT][NEUTRAL] OK. And she does have diagnostic testing under her outpatient coverage. Now, the office visit is not covered.
[AGENT][NEUTRAL] But she has diagnostic testing or procedures or treatments in office. That is under her outpatient benefit of $3000 per calendar year.
[AGENT][NEUTRAL] And that is a verification coverage, not a guarantee of payment.
[CUSTOMER][NEUTRAL] And has any of that been um utilized or does it begin?
[AGENT][NEUTRAL] For, for [PII].
[AGENT][NEUTRAL] Yeah, it's the benefits start over on January the first is a calendar year benefit.
[CUSTOMER][NEUTRAL] So she has all the funds available at this time.
[AGENT][POSITIVE] That's correct.
[CUSTOMER][NEUTRAL] OK, so anything for.
[CUSTOMER][NEUTRAL] January.
[CUSTOMER][NEUTRAL] [PII] then she's eligible for coverage. Anything prior to that she over exceeded the coverage which she would be responsible for, correct?
[AGENT][POSITIVE] That is correct.
[CUSTOMER][POSITIVE] OK, thank you very much I appreciate your help, [PII].
[AGENT][POSITIVE] [PII], it's been a pleasure to assist you with that eligibility and benefits. Thank you for calling APL and I hope you have a wonderful day.
[CUSTOMER][NEUTRAL] You too bye.
[AGENT][POSITIVE] Thank you. Bye-bye.