AccountId: 011433970860
ContactId: 21842c6e-a231-483e-8c61-b256b1c5584e
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 188229 ms
Total Talk Time (AGENT): 85939 ms
Total Talk Time (CUSTOMER): 66161 ms
Interruptions: 2
Overall Sentiment: AGENT=0.2, CUSTOMER=0.7
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/02/04/21842c6e-a231-483e-8c61-b256b1c5584e_20250204T19:24_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 afternoon. This is [PII] and I'm calling from the University of Miami. I'm trying to verify um a patient eligibility and benefit, please.
[AGENT][NEUTRAL] OK, I can help you spell your name for me.
[CUSTOMER][NEUTRAL] [PII]
[AGENT][NEUTRAL] And you're needing eligibility and benefits, is this for service in a doctor's office?
[CUSTOMER][NEUTRAL] Yes, ma'am.
[AGENT][NEUTRAL] OK. What's the policy number, [PII]? Or how do you pronounce your name?
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] [PII]? OK.
[CUSTOMER][NEUTRAL] The member ID is, yes, sorry.
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] OK, so member ID 2284023.
[AGENT][NEUTRAL] And I'll get phone number in case we're disconnected?
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] OK. Give me one moment.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] And what's the patient's name and date of birth?
[CUSTOMER][NEUTRAL] [PII] [PII].
[AGENT][NEUTRAL] Thank you for that information and so we're checking eligibility and then benefits for service in an office setting. I have that information for you. Um, the effective date is [PII].
[AGENT][NEUTRAL] The policy is active at this time?
[AGENT][NEUTRAL] Under this policy?
[AGENT][NEUTRAL] The office visit fee is not covered. Um, there is a treatment rider under this policy, um, whereby covered treatment can be considered under the outpatient benefit.
[CUSTOMER][NEUTRAL] OK. Um, so the, the place of service will be.
[CUSTOMER][NEUTRAL] On outpatient facility.
[AGENT][NEUTRAL] OK, so not in a doctor's office?
[CUSTOMER][NEUTRAL] POS 22.
[CUSTOMER][NEUTRAL] No, I'm just checking here.
[AGENT][NEUTRAL] OK, I thought I heard you say office visit. OK.
[CUSTOMER][NEUTRAL] Yes, I didn't check. I'm sorry, I didn't check the POS, but the POS is 22.
[AGENT][NEUTRAL] OK, so the maximum outpatient benefit is up to $2500.
[AGENT][NEUTRAL] Per calendar year.
[AGENT][NEUTRAL] The information provided is verification, not a guarantee of payment.
[AGENT][NEUTRAL] And upon checking the history, I do not show any claims on file for [PII], so that amount is available at this time.
[AGENT][NEUTRAL] And did you have any other questions we can help out with today?
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Um, can I have a reference number for this call, please?
[AGENT][NEUTRAL] Uh, it will be my name and today's date, [PII] as [PII].
[AGENT][NEUTRAL] O N Y A
[AGENT][NEUTRAL] First initial last name is [PII].
[CUSTOMER][NEUTRAL] OK, it's 24.
[CUSTOMER][POSITIVE] OK, perfect. OK. OK, perfect. Thank you so much.
[AGENT][POSITIVE] Oh, you're welcome and thank you for calling ATLJI. Have a good day.
[CUSTOMER][POSITIVE] Thank you. You too. Bye-bye.