AccountId: 011433970860
ContactId: 1eba9af9-c768-45bd-b714-30347950edec
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 259339 ms
Total Talk Time (AGENT): 88790 ms
Total Talk Time (CUSTOMER): 63689 ms
Interruptions: 0
Overall Sentiment: AGENT=1, CUSTOMER=1.4
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/05/13/1eba9af9-c768-45bd-b714-30347950edec_20250513T15:55_UTC.wav
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[AGENT][POSITIVE] Good
[CUSTOMER][NEUTRAL] The doctor she can.
[AGENT][POSITIVE] Good morning. Thank you for calling. This is [PII]. May I help you?
[CUSTOMER][NEUTRAL] Hello?
[CUSTOMER][NEUTRAL] Hi there, yes ma'am, this is [PII]. Do you need my last initial?
[AGENT][NEUTRAL] Yes, ma'am.
[CUSTOMER][NEUTRAL] OK, [PII].
[AGENT][NEUTRAL] OK, and how may I assist you today, Ms. [PII]?
[CUSTOMER][NEUTRAL] Hey, I am just one first trying to determine if my provider would be in network with you all and then if so if I could get eligibility on an individual.
[AGENT][NEUTRAL] OK. Uh, what is the policy number, please?
[CUSTOMER][NEUTRAL] Yes, certainly, so I have that as 02616308.
[AGENT][NEUTRAL] OK, thank you. And do you have a callback number in case the call drops?
[CUSTOMER][NEUTRAL] Yes, certainly [PII], no extension.
[AGENT][NEUTRAL] OK, thank you. And the patient's name, date of birth?
[CUSTOMER][NEUTRAL] That is [PII] and that is [PII].
[AGENT][POSITIVE] OK, thank you. And give me one moment.
[AGENT][NEUTRAL] Um, well, with this policy, they can go to a multi-plan provider, but it wouldn't affect their benefits or how much we will pay since the policy is a limited indemnity plan, um.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] I don't know. Well, you can contact Multiplan uh to verify if you are participating uh provider with them.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] But this policy is open to where the insurer can go to any medical provider.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK perfect and then could you um give me their benefits level for a professional office visit for psychiatry?
[AGENT][NEUTRAL] OK, uh, let me see if that's covered. Give me one moment and uh see.
[AGENT][NEUTRAL] And uh show his effective date is [PII] and the policy is active.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] And I'm trying to pull up policy information, give me one moment.
[CUSTOMER][POSITIVE] Perfect.
[CUSTOMER][POSITIVE] Sure, yeah, thank you for your assistance.
[AGENT][NEUTRAL] Yes, ma'am.
[AGENT][NEUTRAL] Mhm
[AGENT][NEUTRAL] Mhm
[AGENT][NEUTRAL] Mhm.
[AGENT][NEUTRAL] Mhm
[AGENT][NEUTRAL] See.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] Uh, let's see, not a guarantee of payment, just a verification of coverage. Uh, the max we pay for an office visit is up to $75 per visit and the patient has up to 5 visits total per year.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][POSITIVE] OK, beautiful. All right, thank you for all your assistance. I appreciate it.
[AGENT][POSITIVE] All right, you're welcome. Thank you for calling APL. Have a great day, Ms. [PII].
[CUSTOMER][POSITIVE] Have a great, you too, bye bye.
[AGENT][NEUTRAL] Bye.