AccountId: 011433970860
ContactId: 27f4ad91-9cea-48a1-8354-0e35a7fe3cf0
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 275700 ms
Total Talk Time (AGENT): 88678 ms
Total Talk Time (CUSTOMER): 98454 ms
Interruptions: 1
Overall Sentiment: AGENT=0.9, CUSTOMER=1
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/04/08/27f4ad91-9cea-48a1-8354-0e35a7fe3cf0_20250408T18:45_UTC.wav
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[AGENT][NEUTRAL] Thank you for calling APL. This is [PII]. How can I help you?
[CUSTOMER][POSITIVE] I think it's good for
[CUSTOMER][NEUTRAL] Hello, good afternoon. My name is [PII]. I'm calling from Epiphany Dermatology. I was trying to get some benefits for a patient?
[AGENT][POSITIVE] Um, yes, ma'am. I can assist you with benefits. Um, first, could I get your name again and a good callback number just in case we're disconnected?
[CUSTOMER][NEUTRAL] Yes, [PII], and the phone number is [PII].
[AGENT][NEUTRAL] Thank you, [PII]. Now I need the policy number, please.
[CUSTOMER][POSITIVE] I'm so sorry, what was that?
[AGENT][NEUTRAL] I need the member's policy number.
[CUSTOMER][NEUTRAL] Yes, that's going to be 02566898.
[AGENT][NEUTRAL] OK, thank you. Now, please verify the patient's name and date of birth.
[CUSTOMER][NEUTRAL] Yes. Um, name is.
[CUSTOMER][NEUTRAL] [PII], hi.
[AGENT][NEUTRAL] And his date of birth, please?
[CUSTOMER][NEUTRAL] Um, [PII].
[AGENT][NEUTRAL] OK. Thank you and just let me advise you that verification of coverage does not guarantee payment of claims. The effective date on this policy was [PII]. The policy is still active. And is this for inpatient or outpatient benefits or an office visit?
[CUSTOMER][NEUTRAL] Yeah
[CUSTOMER][NEUTRAL] Yeah, office is it for a specialist, dermatologist?
[AGENT][NEUTRAL] OK, one moment, please.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] I did another
[AGENT][POSITIVE] OK, it'll be just one moment. Its benefits are coming up.
[CUSTOMER][NEUTRAL] Mm.
[CUSTOMER][NEUTRAL] Mhm
[CUSTOMER][NEUTRAL] right yeah.
[CUSTOMER][NEUTRAL] You feel like
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] It was like
[CUSTOMER][NEUTRAL] you
[CUSTOMER][NEUTRAL] Yeah, does it turn the whole 360 or no?
[AGENT][NEUTRAL] OK, thanks for your patience. Um, for office visits, we cover up to $75 per visit and he gets 6 visits per calendar year.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] OK, um, has he used any of those visits by chance?
[AGENT][NEUTRAL] Let's see.
[CUSTOMER][NEUTRAL] Yes
[CUSTOMER][POSITIVE] Thank you.
[AGENT][NEUTRAL] Um, so far, he hasn't used any visits this year.
[CUSTOMER][NEUTRAL] Thank you. And do you know since this this is like uh I'm not sure if it's a limited plan, um, but does he have any benefits for um like procedures done in office with a specialist?
[AGENT][NEUTRAL] Um, yes, it'll be covered under the $75.
[CUSTOMER][NEUTRAL] Like um biopsy.
[AGENT][NEUTRAL] Anything after the 75 is patient responsibility. We just cover up to the 75 per visit.
[CUSTOMER][POSITIVE] Got it, sounds good. OK.
[CUSTOMER][NEUTRAL] Um, I think that should be all I need and can I just get a reference number? Oh, and just to double check, he doesn't with this plan, he doesn't have like no deductible and out of pocket, right?
[AGENT][NEUTRAL] Right, I'm not showing any.
[CUSTOMER][NEUTRAL] Got it. OK, can I just get a reference number?
[AGENT][NEUTRAL] Um, yes, for the reference number, you can use my name in today's date. My name is [PII], um it's spelled [PII] and my last initial is [PII] and today's date. Um, is there anything else I can assist you with?
[CUSTOMER][NEUTRAL] Please.
[CUSTOMER][POSITIVE] No, that should be it. Thank you so much. You have a good day.
[AGENT][POSITIVE] OK, thank you. You do the same, [PII]. Thank you for calling APL. Mm bye.
[CUSTOMER][POSITIVE] Thank you, bye.