AccountId: 011433970860
ContactId: 28d2adc5-30c9-405b-81f3-a55785326da7
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 204839 ms
Total Talk Time (AGENT): 86278 ms
Total Talk Time (CUSTOMER): 35909 ms
Interruptions: 0
Overall Sentiment: AGENT=0.3, CUSTOMER=0.4
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/06/20/28d2adc5-30c9-405b-81f3-a55785326da7_20250620T19:48_UTC.wav
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[AGENT][NEUTRAL] Thank you for calling APL. This is [PII]. How can I help you?
[CUSTOMER][NEUTRAL] Um, hi, good afternoon. My name is [PII]. I'm calling with the provider's office needing to verify eligibility and benefits on a member.
[AGENT][NEUTRAL] All right, [PII], happy to verify eligibility and benefits. What is the patient's policy number?
[CUSTOMER][NEUTRAL] 026.
[CUSTOMER][NEUTRAL] 234 18.
[AGENT][NEUTRAL] Thank you. What is the patient's name and date of birth?
[CUSTOMER][NEUTRAL] [PII], [PII].
[AGENT][POSITIVE] Thank you. They are active. Effective date on here is gonna be [PII].
[CUSTOMER][NEUTRAL] OK, and if I can get benefits for a primary care office visit?
[AGENT][NEUTRAL] Yeah, absolutely. Give me just a second, let me pull the member's policy here.
[AGENT][POSITIVE] Appreciate your patience on that. So it looks like.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] The patient has a limited benefit medical plan, so this is gonna pay a set amount depending upon what they're being seen or treated for. For a physician office visit, it's gonna pay $50 per visit, and they're allowed a total of 4 visits in the calendar year.
[CUSTOMER][NEUTRAL] Are you able to see if they've used any of those visits?
[AGENT][NEUTRAL] Yeah, let me take a look, one moment.
[AGENT][NEGATIVE] Looks like they have not used anything for the year thus far.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] And lastly, where do we need to submit the claims to?
[AGENT][NEUTRAL] Let me just double check on this one. Let's see.
[AGENT][NEUTRAL] Alright, so for this member's policy, claims are going to go to IMA.
[AGENT][NEUTRAL] And that's at [PII].
[AGENT][NEUTRAL] And that is in [PII].
[AGENT][NEUTRAL] The zip code is [PII] and they also have a payer ID if you'd like that.
[CUSTOMER][NEUTRAL] Yes, please.
[AGENT][NEUTRAL] He ID is 64556.
[CUSTOMER][NEUTRAL] All right, that's all that I needed. Is there a reference number for the call?
[AGENT][NEUTRAL] Yeah, absolutely. Call reference is my name with today's date. My name again is [PII], that's [PII] then my last initial [PII] [PII].
[CUSTOMER][POSITIVE] OK, thank you so much. You have a great day.
[AGENT][NEUTRAL] You too bye bye.
[CUSTOMER][NEUTRAL] Bye bye.