AccountId: 011433970860
ContactId: 352f1199-a93f-48b9-98c2-ad9460aeee78
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 157690 ms
Total Talk Time (AGENT): 83741 ms
Total Talk Time (CUSTOMER): 63966 ms
Interruptions: 1
Overall Sentiment: AGENT=1.7, CUSTOMER=2
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/01/30/352f1199-a93f-48b9-98c2-ad9460aeee78_20250130T21:08_UTC.wav
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[AGENT][NEUTRAL] Hey, thank you for calling APL. This is [PII]. How can I help you today?
[CUSTOMER][NEUTRAL] It
[CUSTOMER][NEUTRAL] Hi, yes. I'm calling um for benefits and eligibility, please.
[AGENT][POSITIVE] OK, yeah, I'd love to help you with eligibility and benefits today. May I have your name and a good call back number?
[CUSTOMER][NEUTRAL] I
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Yeah.
[AGENT][NEUTRAL] And then what's a good call back number for you, my friend?
[CUSTOMER][NEUTRAL] [PII]
[AGENT][NEUTRAL] Thank you and the member's policy number?
[CUSTOMER][NEUTRAL] You're very welcome. Of course it's gonna be 203-762-5.
[AGENT][NEUTRAL] Mhm.
[AGENT][POSITIVE] 25. Wonderful, thank you so much.
[CUSTOMER][POSITIVE] You're very welcome.
[AGENT][NEUTRAL] And
[CUSTOMER][NEUTRAL] Yeah, no, I know.
[AGENT][NEUTRAL] Let's see
[AGENT][NEUTRAL] All right. Would you be able to verify your member's first and last name and date of birth for me, please?
[CUSTOMER][NEUTRAL] I think in the morning.
[CUSTOMER][NEUTRAL] Of course it's gonna be for [PII] [PII].
[AGENT][POSITIVE] Perfect, I do see them right here. It looks like they're current and active with an effective date of [PII].
[AGENT][NEUTRAL] And then for benefits were we looking for inpatient or outpatient benefits today?
[CUSTOMER][NEUTRAL] It's, it's gonna be a specialist office visit if there's benefits for that and outpatient surgery.
[AGENT][POSITIVE] OK, perfect. Let me pull that up for you.
[CUSTOMER][POSITIVE] Thank you. Your name is? I'm so sorry.
[AGENT][POSITIVE] My pleasure.
[AGENT][NEUTRAL] Oh, yes, it's [PII].
[CUSTOMER][POSITIVE] Perfect.
[AGENT][NEUTRAL] I, I do want to let you know any benefits I give you over the phone today is just a verification of coverage and not a guarantee of payment.
[CUSTOMER][POSITIVE] Thank you so much.
[AGENT][NEUTRAL] Um, so, your patient, um, this would fall under their outpatient benefits. Um, it looks like their outpatient calendar year maximum is $7500.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] And they do have listed um treatment in an office, so that is a covered rider on their policy.
[CUSTOMER][NEUTRAL] Is it fall with the 7500?
[AGENT][NEUTRAL] Mhm. Yeah, it would fall under that outpatient benefit for you.
[CUSTOMER][POSITIVE] Perfect. And how much has been accumulated?
[AGENT][POSITIVE] Oh, that is a great question. Let me take a look at their calendar year so far.
[CUSTOMER][POSITIVE] Thank you.
[AGENT][NEUTRAL] I'm not showing anything's been used for the [PII] calendar year so far.
[CUSTOMER][NEUTRAL] Um, yeah.
[CUSTOMER][NEUTRAL] OK perfect and the reference number would be your name in today's date, correct?
[AGENT][NEUTRAL] You betcha.
[CUSTOMER][POSITIVE] Perfect you have a great rest of your Thursday, OK?
[AGENT][POSITIVE] Hey my pleasure. You too, take care.
[CUSTOMER][NEUTRAL] Bye.