AccountId: 011433970860
ContactId: 18653446-c78d-488c-bdba-50052849479d
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 750580 ms
Total Talk Time (AGENT): 159302 ms
Total Talk Time (CUSTOMER): 107271 ms
Interruptions: 0
Overall Sentiment: AGENT=0.8, CUSTOMER=-1.1
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/04/08/18653446-c78d-488c-bdba-50052849479d_20250408T13:10_UTC.wav
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[AGENT][NEUTRAL] Thank you for calling APL. This is [PII]. How may I help you?
[CUSTOMER][NEUTRAL] Hi, good morning. I'm calling uh for benefits for a patient that's coming in for a visit and ultrasound in the office.
[AGENT][POSITIVE] OK, I can help you with benefits today.
[CUSTOMER][POSITIVE] Cool.
[AGENT][NEUTRAL] OK. And then do you have the policy number?
[CUSTOMER][NEUTRAL] I do. It is, uh, let's see 01931050.
[CUSTOMER][NEUTRAL] ML 8.
[AGENT][NEUTRAL] Sorry, can you repeat that?
[CUSTOMER][NEUTRAL] Yeah, no problem, actually let me pull up the card just to make sure.
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] It is 0193.
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] 1050.
[CUSTOMER][NEUTRAL] ML 8.
[AGENT][NEUTRAL] OK, let's see.
[AGENT][NEUTRAL] OK and then what's a good call back number in case our call gets dropped?
[CUSTOMER][NEUTRAL] Sure, [PII].
[AGENT][POSITIVE] OK, perfect.
[AGENT][NEUTRAL] OK, and then, um, can you provide your name as well?
[CUSTOMER][NEUTRAL] Yes, my name is [PII].
[AGENT][NEUTRAL] OK
[AGENT][NEUTRAL] All right, [PII], what is the first and last name of the patient and the date of birth?
[CUSTOMER][NEUTRAL] It's [PII] [PII].
[AGENT][POSITIVE] OK, thank you.
[AGENT][NEUTRAL] OK, give me just one second and I'll locate that.
[CUSTOMER][NEUTRAL] Sure.
[AGENT][NEUTRAL] Um, those benefits.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] Alright, so this is not a guarantee of payment. It is just a verification of coverage and it looks like patient has an inpatient benefit max per calendar year is 3000.
[CUSTOMER][NEUTRAL] OK, no outpatient?
[AGENT][NEUTRAL] And it looks like she has an outpatient benefit max per calendar year is also 3000.
[CUSTOMER][NEUTRAL] 3000, has anything been used?
[AGENT][NEUTRAL] Mhm.
[AGENT][NEUTRAL] Let's see
[AGENT][NEGATIVE] So it looks like nothing has been used as of this year.
[CUSTOMER][NEUTRAL] OK. Now with this outpatient, um, does it cover office visits or anything like the diagnostic, uh, ultrasound being done in the office?
[AGENT][NEUTRAL] Mhm.
[AGENT][NEUTRAL] Um, let me see.
[CUSTOMER][NEUTRAL] Mhm
[AGENT][NEUTRAL] OK, let me just put you on a brief hold so I can look deeper into her policy really quick.
[CUSTOMER][NEUTRAL] OK
[AGENT][POSITIVE] OK, thank you.
[CUSTOMER][NEGATIVE] You are on hold.
[CUSTOMER][NEGATIVE] You are on hold.
[CUSTOMER][NEGATIVE] You are on hold.
[CUSTOMER][NEGATIVE] You are on hold.
[CUSTOMER][NEGATIVE] You are on hold.
[AGENT][POSITIVE] Hi, [PII], thank you for holding.
[CUSTOMER][NEUTRAL] Sure.
[AGENT][NEUTRAL] So it looks like the patient does have a rider and that covers treatments in office. And then also, their outpatient benefits. Um, it looks like hospital emergency rooms are covered, urgent care facilities, surgery in hospital, outpatient facility, or freestanding outpatient surgery center, uh, diagnostic testing.
[AGENT][NEUTRAL] Outpatient facility or MRI facility, outpatient treatment for mental or emotional disorder, uh, physical therapy facility, ambulance.
[AGENT][NEUTRAL] And these are all subject to a maximum of 30 days of treatment per covered person per calendar year.
[AGENT][NEUTRAL] So,
[CUSTOMER][NEUTRAL] OK, so I'm just looking for ultrasound in the office. So, um, I think you said that uh something about a writer.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] Mhm, so she has an office treatment writer, so that just means.
[AGENT][NEUTRAL] Um, that we could cover the office treatment for today.
[CUSTOMER][NEUTRAL] Got it. OK, alright, now how about um office visit?
[AGENT][NEUTRAL] Let's see.
[CUSTOMER][NEUTRAL] Typically, like I, I haven't found that a very many gaps do cover the, the office visit. I, I have to ask.
[AGENT][NEUTRAL] Mhm.
[AGENT][NEUTRAL] OK. So it looks like that's not covered.
[CUSTOMER][NEUTRAL] OK, all right, no problem. um do you have effective dates on the patient on the plan?
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] Let's see, I do.
[AGENT][NEUTRAL] OK, so her policy is active and the effective date is [PII].
[CUSTOMER][POSITIVE] Perfect. OK.
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Alrighty, I think that's it. What was your name again? I'm sorry.
[AGENT][NEUTRAL] My name is [PII].
[CUSTOMER][NEUTRAL] Any reference number for our call?
[AGENT][NEUTRAL] Mhm.
[AGENT][NEUTRAL] Yes, so it would be [PII].
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] And then my last initial is [PII]
[AGENT][NEUTRAL] And it would be today's date.
[CUSTOMER][POSITIVE] Got it. [PII]. Alright, perfect. Thank you so much for your help.
[AGENT][NEUTRAL] Mhm.
[AGENT][POSITIVE] All right, thank you. Um, is there anything else I can help you with?
[CUSTOMER][POSITIVE] No, that's it good to go.
[AGENT][POSITIVE] OK. Thank you for calling APL. Have a good day.
[CUSTOMER][NEUTRAL] Bye.
[AGENT][NEUTRAL] Alright, bye.