AccountId: 011433970860
ContactId: 26b2f94f-a0ee-4e24-a431-49c05441cc49
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 210059 ms
Total Talk Time (AGENT): 90694 ms
Total Talk Time (CUSTOMER): 55430 ms
Interruptions: 0
Overall Sentiment: AGENT=0.9, CUSTOMER=0.6
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/01/17/26b2f94f-a0ee-4e24-a431-49c05441cc49_20250117T19:37_UTC.wav
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[AGENT][NEUTRAL] Calling AP. This is [PII]. How can I help you?
[CUSTOMER][POSITIVE] Um, hi, [PII], I'm calling to get an eligibility and benefits for one of our patients.
[AGENT][NEUTRAL] OK, may I have your name please?
[CUSTOMER][NEUTRAL] [PII]
[AGENT][POSITIVE] Thank you and your call back here brief we were disconnected please.
[CUSTOMER][NEUTRAL] [PII].
[AGENT][POSITIVE] Thank you very much. What is that policy number please so I can assist you?
[CUSTOMER][NEUTRAL] Let me just pull it up.
[CUSTOMER][NEUTRAL] Uh, [PII], what's your initial?
[AGENT][NEUTRAL] The last initial is [PII] like.
[AGENT][NEUTRAL] [PII]?
[CUSTOMER][NEUTRAL] Thank you. Member ID is [PII] Mama [PII].
[AGENT][NEUTRAL] OK, let me just repeat that just to make sure I have those 0s and 3 in the correct order. I have that as 02003103 ML 8.
[CUSTOMER][NEUTRAL] Yes.
[AGENT][NEUTRAL] Verify the patient's name and date of birth.
[CUSTOMER][NEUTRAL] [PII], [PII].
[AGENT][NEUTRAL] OK, thank you very much for the verification process and you're calling for eligibility. Would you need benefits as well?
[CUSTOMER][NEUTRAL] Yes, uh, specialist visit.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] OK, I can assist you with benefits as well. Um, her policy shows effective as of [PII]. Her policy shows active as the supplemental medical.
[AGENT][NEUTRAL] And bear with me. Let me check to see if there's benefit for an office visit specialist.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][POSITIVE] Thank you.
[AGENT][NEUTRAL] OK, the policy does not cover for an office visit that could be with a PCP or a specialist, so there's no benefit for an office visit.
[CUSTOMER][NEUTRAL] Mm
[CUSTOMER][NEUTRAL] Uh, what's the, is there an outpatient benefit maximum?
[AGENT][NEUTRAL] Uh yes, there is. Please note verification of benefits.
[AGENT][NEUTRAL] Provided does not guarantee payment, we will pay up to $7350.
[CUSTOMER][NEUTRAL] 7350.
[AGENT][NEUTRAL] Yes.
[CUSTOMER][NEUTRAL] That's the maximum, but uh as of now, what's the accumulation? What's the remaining?
[AGENT][NEUTRAL] One moment.
[AGENT][NEGATIVE] Currently the member has all remaining no benefits have been used for [PII].
[CUSTOMER][NEUTRAL] All right. All right. Uh, what's the reference number for this call?
[AGENT][NEUTRAL] We do not use reference numbers. Rea you can use my name and today's date. Anything else I can assist you with, please?
[CUSTOMER][POSITIVE] Uh, that will be all. Thank you so much, [PII].
[AGENT][POSITIVE] You're very welcome. Thank you for calling APL. Have a great day mm bye.
[CUSTOMER][NEUTRAL] Bye bye.