AccountId: 011433970860
ContactId: 2e4cf7bd-d7a6-4adb-a45c-a0786cf00410
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 393040 ms
Total Talk Time (AGENT): 115178 ms
Total Talk Time (CUSTOMER): 114036 ms
Interruptions: 0
Overall Sentiment: AGENT=0.6, CUSTOMER=0.2
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/05/08/2e4cf7bd-d7a6-4adb-a45c-a0786cf00410_20250508T12:59_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 morning, [PII]. My name is [PII]. I would just like to get benefit information for one of our patients.
[AGENT][POSITIVE] All right, I'm happy to check on if it's for you today. Do we have a policy number for the patient?
[CUSTOMER][NEUTRAL] Um, policy number is 02509836.
[AGENT][POSITIVE] Thank you.
[CUSTOMER][NEUTRAL] [PII]. Can I have your initial?
[AGENT][NEUTRAL] Uh, yeah, initial is [PII].
[CUSTOMER][POSITIVE] Thank you.
[AGENT][NEUTRAL] Patient's name and date of birth?
[CUSTOMER][NEUTRAL] [PII], [PII].
[AGENT][POSITIVE] All right. Thank you so much. So, patient is active. Effective date is [PII].
[AGENT][NEUTRAL] And we are the members 2nd.
[CUSTOMER][NEUTRAL] Is specialist office visit covered?
[AGENT][NEUTRAL] Uh, yeah, we're the secondary insurance, so this will cover deductible, co-pay, co-insurance that the primary does not.
[AGENT][NEUTRAL] The outpatient benefit max on this plan?
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] How much?
[AGENT][NEUTRAL] Looks like it is 8700.
[CUSTOMER][NEUTRAL] Sorry, 81.
[AGENT][NEUTRAL] 8700.
[CUSTOMER][NEUTRAL] And how much is the accumulation?
[AGENT][NEUTRAL] Let me see what they've used one moment.
[AGENT][NEGATIVE] Not showing anything used as of today.
[CUSTOMER][NEUTRAL] The patients still have the 48,700.
[AGENT][NEUTRAL] Yes.
[CUSTOMER][NEUTRAL] And it's not clear to me is specialist covered?
[CUSTOMER][NEUTRAL] It will, it, is it or it's not?
[AGENT][NEUTRAL] Yes, it is.
[CUSTOMER][NEUTRAL] It is
[CUSTOMER][NEUTRAL] One moment.
[CUSTOMER][NEUTRAL] Hold on.
[CUSTOMER][NEUTRAL] Yeah that's.
[CUSTOMER][NEUTRAL] Um, what's the reference number for this patient?
[AGENT][NEUTRAL] It would be my name with my last initial in today's date.
[CUSTOMER][NEUTRAL] [PII].
[CUSTOMER][NEUTRAL] Got it. Can I ask for another patient? I only have 2 for the day.
[AGENT][NEUTRAL] Yeah, what's the next patient's policy number?
[CUSTOMER][NEUTRAL] Uh, policy number.
[CUSTOMER][NEUTRAL] It's 256-04. No, no, no, sorry.
[CUSTOMER][NEUTRAL] Um,
[CUSTOMER][NEUTRAL] Mhm
[CUSTOMER][NEUTRAL] I don't have a policy number because on the card it doesn't have a policy number.
[AGENT][NEUTRAL] OK, we can search by name. What's their last name?
[CUSTOMER][NEUTRAL] Hold on
[CUSTOMER][NEUTRAL] Uh, their last name is [PII], [PII].
[AGENT][NEUTRAL] So [PII]
[CUSTOMER][NEUTRAL] Yes.
[CUSTOMER][NEUTRAL] Yes.
[AGENT][NEUTRAL] First name?
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] Yeah.
[AGENT][NEUTRAL] [PII]
[CUSTOMER][NEUTRAL] Date of birth [PII].
[CUSTOMER][NEUTRAL] Yeah, [PII], [PII].
[AGENT][NEUTRAL] Patient policy number, are you ready for that?
[CUSTOMER][NEUTRAL] Yes.
[AGENT][NEUTRAL] 02221660.
[CUSTOMER][NEUTRAL] 02221660.
[AGENT][NEUTRAL] Correct. Patients active. Effective date is [PII]. We are the members secondary insurance on this, so this covers the deductible co-pay, co-insurance as well.
[CUSTOMER][NEUTRAL] Is specialist uh visit covered?
[CUSTOMER][NEUTRAL] Hello, [PII]?
[AGENT][NEUTRAL] Let me check here. Yeah, one moment, please.
[CUSTOMER][NEUTRAL] All right. I thought I lost you.
[AGENT][NEUTRAL] All right, so patient plan will cover uh treatment in a physician's office. It does not cover the physician office visit fee.
[CUSTOMER][NEUTRAL] How much is the outpatient benefit maximum?
[AGENT][NEUTRAL] 3500 for the for the calendar year.
[CUSTOMER][NEUTRAL] And the accumulation.
[AGENT][NEUTRAL] And the patient has not used anything.
[CUSTOMER][NEUTRAL] And same reference number, your name and today's date.
[AGENT][POSITIVE] Correct.
[CUSTOMER][NEUTRAL] Sure.
[CUSTOMER][POSITIVE] Alright, that's all for today thank you so much.
[AGENT][NEUTRAL] You're welcome, [PII]. Bye-bye.