AccountId: 011433970860
ContactId: 2d3e8b19-b7b6-4794-9a50-5b02ac29ae51
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 226089 ms
Total Talk Time (AGENT): 85030 ms
Total Talk Time (CUSTOMER): 119531 ms
Interruptions: 6
Overall Sentiment: AGENT=1, CUSTOMER=0.6
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/05/08/2d3e8b19-b7b6-4794-9a50-5b02ac29ae51_20250508T17:48_UTC.wav
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[AGENT][POSITIVE] Good afternoon. Thank you for calling APL. My name is [PII]. How may I help you?
[CUSTOMER][NEUTRAL] Hello, my name is [PII]
[CUSTOMER][NEUTRAL] Hi, [PII]. This is [PII]. I'm here to verify member eligibility.
[AGENT][POSITIVE] OK, well, I'll be more than happy to help you with the eligibility. And [PII], may I have a good contact number in case we're disconnected and the policy number?
[CUSTOMER][POSITIVE] Yeah, I'll be more than happy to help you with the eligibility and so we may now have a good time.
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] Yes. The callback number is [PII] and it's a direct line.
[CUSTOMER][NEUTRAL] And member ID is?
[CUSTOMER][NEUTRAL] 01972960
[AGENT][NEUTRAL] Thank you, hold on one moment.
[CUSTOMER][NEUTRAL] Hm
[AGENT][NEUTRAL] And can you verify the member's first and last name and date of birth?
[CUSTOMER][NEUTRAL] Yes, the member's name is [PII] and date of birth is [PII].
[AGENT][NEUTRAL] Thank you for that and all the information provided is a verification of benefits, not a guarantee of payment, and I am showing the policy is active. It's been effective since [PII].
[CUSTOMER][NEUTRAL] [PII]. OK. So, as this is the secondary insurance, so will it cover the primary insurance patient's responsibility like deductible, co-pay, and co-insurance?
[AGENT][NEUTRAL] Yes, we pay towards the copay, deductible and co-insurance of coverage charges after primary. Um, if you're considered.
[CUSTOMER][NEUTRAL] And co-insurance will cover charges after primary, um, if you're considered prime.
[AGENT][NEUTRAL] Well, actually,
[CUSTOMER][NEUTRAL] Well, actually,
[AGENT][NEUTRAL] Hold on one moment.
[CUSTOMER][NEUTRAL] Hold on one moment.
[CUSTOMER][NEUTRAL] If the services is going to be performed in office, specialist office, what are the benefits?
[AGENT][NEUTRAL] Give me just a moment. I'm waiting for them to come up.
[CUSTOMER][NEUTRAL] So just a moment. I'm waiting for them to come up.
[AGENT][POSITIVE] Thank you.
[CUSTOMER][POSITIVE] Thank you.
[AGENT][NEUTRAL] Alright, so for outpatient the policy will pay up to $500 per occurrence.
[CUSTOMER][NEUTRAL] Alright, so for outpatient the policy will pay up to $500 per occurrence.
[CUSTOMER][NEUTRAL] For outpatients.
[CUSTOMER][NEUTRAL] Office, it will pay 500 5000.
[AGENT][NEUTRAL] 500.
[CUSTOMER][NEUTRAL] 500, 500. OK. And for office visit.
[AGENT][NEUTRAL] Her occurrence.
[AGENT][NEUTRAL] So for the office visit, it will pay up to $25 per visit with a max of 4 visits per calendar year.
[CUSTOMER][NEUTRAL] So for the office visit, it'll pay up to $25 per visit with the max of 4 visits per calendar year. OK. And after 4, how many have been used?
[AGENT][NEUTRAL] Hold on one moment.
[CUSTOMER][NEUTRAL] Hold on one moment.
[AGENT][NEGATIVE] For 2025, none of the benefits have been used yet.
[CUSTOMER][NEUTRAL] For 2025, none of the benefits have been used. OK. And out of $500 how, how many has been accumulated by the patient?
[AGENT][NEGATIVE] Um, none of the benefits have been used for this year yet.
[CUSTOMER][NEGATIVE] Um, none of the benefits have been used for this year yet.
[CUSTOMER][NEUTRAL] So if the service is going to be performed in the office, it will be covered, right?
[AGENT][NEUTRAL] The only way to guarantee is to process the claim, but there are the benefits here.
[CUSTOMER][NEUTRAL] The only way to guarantee is to process the claim, but there are the benefits here. OK.
[CUSTOMER][NEUTRAL] Thank you. Could you please provide me your name and our call reference number?
[AGENT][POSITIVE] You're welcome.
[AGENT][NEUTRAL] Sure, my name is [PII], first initial and my last name is [PII].
[CUSTOMER][NEUTRAL] Sure, my name is [PII]
[AGENT][NEUTRAL] And there's no call reference number, but you can use my name in today's date.
[CUSTOMER][POSITIVE] OK, [PII], thank you so much.
[AGENT][POSITIVE] You're very welcome. Was there anything else I can assist you with today?
[CUSTOMER][POSITIVE] No, that's all for today and now. Thank you.
[AGENT][POSITIVE] Alright, [PII]. You're welcome. Thanks for calling APL. Bye-bye.
[CUSTOMER][NEUTRAL] Bye.