AccountId: 011433970860
ContactId: 2d36d4ce-8577-459a-bc11-e50d5dd882d6
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 214580 ms
Total Talk Time (AGENT): 88068 ms
Total Talk Time (CUSTOMER): 58761 ms
Interruptions: 0
Overall Sentiment: AGENT=1.1, CUSTOMER=0.6
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/05/29/2d36d4ce-8577-459a-bc11-e50d5dd882d6_20250529T19:18_UTC.wav
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[AGENT][NEUTRAL] Thank you for calling APL. This is [PII]. How can I help you?
[CUSTOMER][NEUTRAL] Hi, uh, my name is [PII]. I'm calling from a provider's office. I'm just calling to check for eligibility and benefits for a patient.
[AGENT][POSITIVE] OK, yeah, I can check eligibility and benefits for you. Uh, [PII], can I get a good call back number from you first in case we're disconnected please?
[CUSTOMER][NEUTRAL] Yeah, my direct contact number is [PII].
[AGENT][NEUTRAL] OK, thank you. And then do you have the policy number?
[CUSTOMER][NEUTRAL] Policy number is.
[CUSTOMER][NEUTRAL] 02606091.
[AGENT][NEUTRAL] OK and then what was the name and date of birth for the member please?
[CUSTOMER][NEUTRAL] It's for [PII]. Date of birth is [PII].
[AGENT][POSITIVE] Perfect, thank you for verifying that, [PII]. Uh, so this policy is active, effective date was [PII].
[CUSTOMER][NEUTRAL] You, can you please tell me what's the benefits for a specialist office visit?
[AGENT][NEUTRAL] Sure, so I will tell you this is a limited indemnity medical plan, so, uh, it pays a set dollar amount per covered procedure or office visit.
[AGENT][NEUTRAL] So give me just a moment. Let me get that policy pulled up and check to see if that is covered.
[CUSTOMER][POSITIVE] Thank you.
[AGENT][NEUTRAL] OK, and of course I will let you know verification of coverage is not a guarantee of payment for claims. Uh, so for office visits, uh, this policy pays $75 per visit.
[CUSTOMER][NEUTRAL] Hm.
[CUSTOMER][NEUTRAL] Alright, yeah, is there any patient responsibility for the $75?
[AGENT][NEUTRAL] The $75 is the benefit amount that we would pay. That's the maximum amount we would pay per visit.
[CUSTOMER][NEUTRAL] I see and the difference would be the patient responsibility?
[AGENT][NEUTRAL] We don't say what is patient responsibility that would be up to the provider.
[CUSTOMER][NEUTRAL] I see, I see.
[CUSTOMER][NEUTRAL] All right.
[CUSTOMER][NEUTRAL] Uh, is there any other limitation aside from the $75 per appointment?
[AGENT][NEUTRAL] Uh, they are limited to, let's see, 5 visits per calendar year. So if you'll give me one moment, I'll see if she's, uh, used any so far this year.
[AGENT][NEUTRAL] OK, so so far she has used 2 visits so far this year.
[CUSTOMER][NEUTRAL] Q S X
[CUSTOMER][NEUTRAL] OK, uh, I think that's all I need right now. Can I get a reference number please?
[AGENT][NEUTRAL] Sure, reference number would just be my first name, last initial, and today's date. Uh, so my name is spelled [PII] last [PII] and there was anything else I could help you with, [PII]?
[CUSTOMER][NEUTRAL] Yeah
[CUSTOMER][POSITIVE] That's all, thank you for your help, [PII]. Have a good day.
[AGENT][POSITIVE] Alright, yeah, thanks for calling APL you too bye bye.
[CUSTOMER][NEUTRAL] Alright bye bye.