AccountId: 011433970860
ContactId: 3714429d-0066-476b-9dd0-b8e7f09ed396
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 299130 ms
Total Talk Time (AGENT): 128540 ms
Total Talk Time (CUSTOMER): 85575 ms
Interruptions: 0
Overall Sentiment: AGENT=0.4, CUSTOMER=0.9
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/03/05/3714429d-0066-476b-9dd0-b8e7f09ed396_20250305T18:48_UTC.wav
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[AGENT][POSITIVE] Thank you for calling APL this is [PII] how may I help you?
[CUSTOMER][NEUTRAL] You
[CUSTOMER][NEUTRAL] [PII], this is [PII] calling from the Private diagnostic Clinic. This is regarding the eligibility and benefits information. Could you please assist with that?
[AGENT][NEUTRAL] OK, and um [PII] you said you're calling from primary diagnostic clinic and what was the um nature of the call?
[CUSTOMER][NEUTRAL] It's for eligibility and benefits information.
[AGENT][NEUTRAL] Eligibility and benefits for patients.
[CUSTOMER][POSITIVE] Yes, that's correct.
[AGENT][NEUTRAL] OK thank you sir and then what is your callback number just in case disconnected?
[CUSTOMER][NEUTRAL] [PII]. It's a direct line.
[AGENT][NEUTRAL] OK. And then what is the patient's name, date of birth, and policy number?
[CUSTOMER][NEUTRAL] Sure. The patient's name is [PII]. The date of birth is [PII].
[CUSTOMER][NEUTRAL] The policy number is 945138.
[AGENT][NEUTRAL] 945138 is the policy number?
[CUSTOMER][POSITIVE] Yes, that's correct.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] OK, I do show that [PII] does have an active policy. Her effective date is [PII].
[AGENT][NEUTRAL] And this is just to verify her benefits. It's not a guarantee of payment. This is a supplemental insurance policy that is billed secondary to the primary. The policy helps with deductible, co-pay, and co-insurance.
[AGENT][NEUTRAL] She has an inpatient benefit amount per calendar year of $5000 and then she also has an outpatient calendar year.
[AGENT][NEUTRAL] Benefit of $4000.
[CUSTOMER][NEUTRAL] OK, uh,
[AGENT][NEUTRAL] For medical or sickness, for accident or sickness.
[CUSTOMER][NEUTRAL] Yes, um,
[CUSTOMER][NEUTRAL] Yes, uh, I need, uh, in-network benefits.
[AGENT][NEGATIVE] You need what benefits, sir? I'm having a hard time hearing you.
[CUSTOMER][NEUTRAL] Bye.
[CUSTOMER][NEUTRAL] Yes, yes. I need in-network benefits.
[AGENT][NEUTRAL] And what kind of benefits? I'm, can you repeat that again?
[CUSTOMER][NEUTRAL] Sure. It's, I need in benefits like co-pay, initial deductible, and maximum out of pocket. Could you please tell me for me?
[AGENT][NEUTRAL] Uh, there isn't one because this helps with deductible copay and co-insurance.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] Inpatient, um.
[AGENT][NEUTRAL] Or outpatient.
[CUSTOMER][NEUTRAL] It's for uh outpatient.
[AGENT][NEUTRAL] Right, she has an outpatient benefit of $4000 per calendar year for accident or sickness.
[CUSTOMER][NEUTRAL] It's for deductible, correct?
[AGENT][POSITIVE] It, it helps with deductible, co-pay or co-insurance.
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] And may I know the accumulation amount?
[AGENT][NEUTRAL] Yes, let me check for you to see if she's used anything.
[CUSTOMER][NEUTRAL] Yes, I, I want the maximum out of pocket and their accumulation.
[AGENT][NEUTRAL] She has not used anything for the 2025.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] And
[AGENT][NEUTRAL] The maximum is $4000 per year.
[CUSTOMER][NEUTRAL] The
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][POSITIVE] Thank you so much for the information and uh.
[CUSTOMER][NEUTRAL] Could you please say your name with the last name [PII]? Could you please spell that?
[AGENT][NEUTRAL] Yes
[AGENT][NEUTRAL] Yes, my name is [PII] and the last initial is [PII]
[CUSTOMER][NEUTRAL] [PII] and the last initial is [PII] Thank you so much, [PII]. And could you please uh provide the call reference number?
[AGENT][NEUTRAL] Yes, you can use my name and today's date.
[CUSTOMER][POSITIVE] Sure, sure, [PII]. And thank you so much for the information, the assistance story. It's been a pleasure talking with you. Have a good day. Bye for now.
[AGENT][POSITIVE] You too JD and thank you for calling APL. You have a good day also you take.
[AGENT][NEUTRAL] OK. Bye-bye.
[CUSTOMER][POSITIVE] Thank you sir.
[CUSTOMER][NEUTRAL] Bye.