AccountId: 011433970860
ContactId: 18b9bfff-c5ab-44f1-9e17-7a8c8505bd0c
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 184660 ms
Total Talk Time (AGENT): 96816 ms
Total Talk Time (CUSTOMER): 62300 ms
Interruptions: 0
Overall Sentiment: AGENT=2.8, CUSTOMER=1.1
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/01/29/18b9bfff-c5ab-44f1-9e17-7a8c8505bd0c_20250129T14:06_UTC.wav
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[AGENT][POSITIVE] Good Morning, thank you for calling APL. My name is [PII]. How may I help you?
[CUSTOMER][NEUTRAL] Good morning, [PII]. Um, I'm trying to get the patient benefits and eligibility for specialist office visit.
[AGENT][POSITIVE] It would be my pleasure to assist you. May I ask your name?
[CUSTOMER][NEUTRAL] Mhm. My name is [PII] spelled [PII]
[AGENT][POSITIVE] Thank you [PII] and a good callback number.
[CUSTOMER][NEUTRAL] Area code [PII].
[AGENT][POSITIVE] [PII]. Thank you.
[AGENT][NEUTRAL] And what is the policy number for the patient?
[CUSTOMER][NEUTRAL] 01885462 M. like Mary L. 8.
[AGENT][NEUTRAL] All right, thank you. And what is the patient's name and date of birth, please, ma'am?
[CUSTOMER][NEUTRAL] [PII] Date of birth [PII].
[AGENT][NEUTRAL] All right, thank you, and it would be my pleasure to assist you today with eligibility and benefits for [PII]. I'm showing her policy is active. Effective date is [PII]. This is a secondary policy to her major medical insurance. And what type of benefits are you needing?
[CUSTOMER][NEUTRAL] For specialist office visit?
[AGENT][NEUTRAL] All right, thank you. Now, [PII], for the office visit co-pay, we do not cover the office visit. She does have benefits for treatments or procedures performed in a doctor's office, but no benefits for the visit.
[CUSTOMER][NEUTRAL] Oh.
[CUSTOMER][NEUTRAL] Um for the, OK, for the office visit, you're gonna cover the copay. But for any, any testing done in the office, it's covered.
[AGENT][POSITIVE] That's right.
[AGENT][POSITIVE] That is correct.
[CUSTOMER][NEUTRAL] Oh OK.
[AGENT][NEUTRAL] Or procedures in office.
[CUSTOMER][NEUTRAL] Or procedure.
[CUSTOMER][POSITIVE] It's covered, it's 100%.
[AGENT][NEUTRAL] It's covered up to the benefit amount, and that benefit amount is $500 per calendar day.
[AGENT][NEUTRAL] That we can pay toward her deductible or co-insurance of her major medical for those procedures and treatments in office.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK. And this is a PPO plan?
[AGENT][NEUTRAL] No, ma'am, it's just a secondary policy. We follow the guidelines of the major medical.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] So that's all I needed, [PII]. Can I have a reference number?
[AGENT][NEUTRAL] Reference number is my name and today's date, and I spell my name [PII], if you would please note that all benefits given over the phone is a verification of coverage, not a guarantee of payment.
[AGENT][NEUTRAL] Anything else I can help you with today?
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][POSITIVE] That will be all. Thank you.
[AGENT][POSITIVE] Thank you for calling APL. Hope you have a wonderful day.
[CUSTOMER][POSITIVE] Thank you you too bye bye.
[AGENT][NEUTRAL] Bye-bye.