AccountId: 011433970860
ContactId: 2478edf4-5aca-46ae-8db0-4acf047cfefc
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 399320 ms
Total Talk Time (AGENT): 121575 ms
Total Talk Time (CUSTOMER): 98312 ms
Interruptions: 0
Overall Sentiment: AGENT=0.4, CUSTOMER=0.4
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/03/07/2478edf4-5aca-46ae-8db0-4acf047cfefc_20250307T17:31_UTC.wav
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[AGENT][NEUTRAL] Thank you for calling and APL. This is [PII]. How may I help you?
[CUSTOMER][NEUTRAL] Hi, good day. My name is [PII]. I'd like to check and verify benefits and eligibility for a member.
[AGENT][NEUTRAL] OK, Ms. [PII], I can help you with benefits and eligibility. What is your callback number, ma'am?
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] Thank you and then what is the name of the facility you're calling from, please?
[CUSTOMER][NEUTRAL] Sleep snoring and sinus clinic.
[AGENT][NEUTRAL] OK, and then what's the name of the patient, the date of birth, and the policy number?
[CUSTOMER][NEUTRAL] OK. So let's start with the policy number. That will be 015309.
[CUSTOMER][NEUTRAL] 09 M as in Mary, L as in Lima, number 8.
[CUSTOMER][NEUTRAL] And the name is [PII] with date of birth, [PII].
[AGENT][NEUTRAL] OK, let me pull up that policy for us real quick.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] All right, I do show that
[AGENT][NEUTRAL] [PII] does have an active policy and his effective date is [PII].
[AGENT][NEUTRAL] And this is just to verify his benefits. It's not a guarantee of payment.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] He has a supplemental insurance policy that is a gap insurance billed secondary to the primary. It helps with deductible, co-pay, and co-insurance. He has an inpatient calendar year benefit amount of $5000 and then he also has an outpatient calendar year benefit amount of $2500.
[CUSTOMER][NEUTRAL] I'm sorry, ma'am. The line is cutting. Can you start with the uh I heard $500.
[AGENT][NEUTRAL] 5000.
[AGENT][NEUTRAL] For inpatient and then for outpatient is $2500.
[CUSTOMER][NEUTRAL] Oh, sorry.
[CUSTOMER][NEUTRAL] Outpatient.
[CUSTOMER][NEUTRAL] For the outpatient, the, um,
[CUSTOMER][NEUTRAL] 20
[CUSTOMER][NEUTRAL] $500 will be
[CUSTOMER][NEUTRAL] Let me just check here.
[AGENT][NEUTRAL] Yes, are you still there?
[CUSTOMER][NEUTRAL] Yes, ma'am.
[CUSTOMER][NEUTRAL] The $2500 outpatient is under which, ma'am?
[AGENT][NEUTRAL] Under [PII] and our company is APL.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] May I ask, ma'am, if uh
[AGENT][NEUTRAL] May you ask what please?
[CUSTOMER][NEUTRAL] If the office visit.
[CUSTOMER][NEUTRAL] Yeah, if the um
[CUSTOMER][NEUTRAL] If the secondary will cover the um
[CUSTOMER][NEUTRAL] Office visit.
[AGENT][NEUTRAL] OK, let me look real quick. I'm gonna pull his policy up and read the policy and see if office visits are covered under this policy.
[CUSTOMER][POSITIVE] OK, thank you.
[AGENT][NEUTRAL] Office visits are not covered under this policy.
[CUSTOMER][NEUTRAL] OK
[CUSTOMER][POSITIVE] OK, thank you.
[AGENT][NEUTRAL] Is there anything else I can help you with before we go?
[CUSTOMER][NEUTRAL] I just wanted, uh, my question earlier, ma'am, uh for the
[CUSTOMER][NEUTRAL] The, for the 2500, it falls under what?
[AGENT][NEUTRAL] It, it's for deductible, co-pay, or co-insurance.
[AGENT][NEUTRAL] For outpatient.
[CUSTOMER][NEUTRAL] For this, OK. Outpatient, OK.
[CUSTOMER][NEUTRAL] Copay and go Insurance. OK.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][POSITIVE] OK, if that'll be all I appreciate you calling APL. I hope you have a wonderful weekend.
[CUSTOMER][NEUTRAL] And do you have a reference number for me, ma'am, and your last name initial?
[AGENT][NEUTRAL] Yes, the reference number would be my name [PII]
[AGENT][NEUTRAL] The last initial is [PII] and today's date.
[CUSTOMER][POSITIVE] All right, thank you, sorry you have a great day.
[AGENT][NEUTRAL] You too.
[AGENT][POSITIVE] Care Miss [PII], thanks for calling APL bye bye.
[CUSTOMER][NEUTRAL] Right.