AccountId: 011433970860
ContactId: 2d769385-1387-4d49-864e-2cf2f9197b7d
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 131800 ms
Total Talk Time (AGENT): 70799 ms
Total Talk Time (CUSTOMER): 50783 ms
Interruptions: 0
Overall Sentiment: AGENT=1.3, CUSTOMER=0.8
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/03/31/2d769385-1387-4d49-864e-2cf2f9197b7d_20250331T15:32_UTC.wav
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[AGENT][NEUTRAL] Thank you for calling APL. This is [PII]. How can I help you?
[CUSTOMER][NEUTRAL] Hi, my name is [PII]. I'm calling from Chris's Health Insurance. I need to see if a member has eligibility for an outpatient surgery.
[AGENT][NEUTRAL] Yeah
[AGENT][NEUTRAL] Sure, I can check that eligibility for you. uh, [PII], can I get a good call back number from you first in case we're disconnected?
[CUSTOMER][NEUTRAL] [PII]
[AGENT][NEUTRAL] Thank you. And then do you have that policy number?
[CUSTOMER][NEUTRAL] Um, the number I have here is 1456751.
[AGENT][NEUTRAL] OK, and what was the name and date of birth for the member, please?
[CUSTOMER][NEUTRAL] [PII] [PII].
[AGENT][NEUTRAL] Perfect, thank you for verifying that, [PII]. Uh, so this policy is active. Effective date was [PII], and this is a secondary medical policy, so it is designed to help with co-pay, deductible and co-insurance after major medical pays.
[CUSTOMER][NEUTRAL] OK, I just really needed to know if you know if it was not one of those plans that is like a set amount and everything like that, so he's good, he's eligible and whatever his Blue Cross doesn't cover this is secondary we'll pick it up.
[AGENT][NEUTRAL] Oh, of course.
[AGENT][NEUTRAL] It is
[AGENT][NEUTRAL] It does
[AGENT][NEUTRAL] Yes, it does have a limited amount though, um, and of course I will let you know verification of coverage is not a guarantee of payment for claims uh so for the outpatient benefit um it is $500 max per calendar year is the total amount for outpatient um that we would offer and if you'll give me one moment I'll see if any of that has been used.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] OK, and he's
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] OK, so none has been used before this year.
[CUSTOMER][NEUTRAL] All right, and that's that's for surgeries, imaging and everything anything outpatient?
[AGENT][POSITIVE] Correct. Anything outpatient, yes.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][POSITIVE] Alrighty and thank you so very much I appreciate your time.
[AGENT][NEUTRAL] Of course, yeah, was there anything else I can help you with?
[CUSTOMER][NEUTRAL] No, that'll be it.
[AGENT][POSITIVE] Alright, well thanks for calling API. I hope you have a great rest of your day.
[CUSTOMER][POSITIVE] You you too bye bye.
[AGENT][POSITIVE] Thank you, bye bye.