AccountId: 011433970860
ContactId: 39622265-5de1-4221-a468-c7e6f7cf7b51
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 455880 ms
Total Talk Time (AGENT): 172023 ms
Total Talk Time (CUSTOMER): 99801 ms
Interruptions: 1
Overall Sentiment: AGENT=0.9, CUSTOMER=1.9
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/01/02/39622265-5de1-4221-a468-c7e6f7cf7b51_20250102T15:09_UTC.wav
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[AGENT][POSITIVE] Thank you for calling APL this is [PII] how may I help you?
[CUSTOMER][NEUTRAL] Hi [PII], good morning. My name is [PII], initial [PII]. I'm calling because I just wanted to confirm that a patient's plan is still currently active and um that also that it would cover her copays and deductibles in a specialist office.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] OK, um, I can help you with eligibility and benefits Ms. [PII], can I please get your call back number just in case our call is disconnected?
[CUSTOMER][NEUTRAL] Sure, my callback number is [PII].
[AGENT][NEUTRAL] OK, thank you. And then what's the patient's name?
[CUSTOMER][NEUTRAL] Um, her name is [PII].
[AGENT][NEUTRAL] OK. And what is the date of birth of Ms. [PII]?
[CUSTOMER][NEUTRAL] Is [PII].
[AGENT][NEUTRAL] And what is her policy number, please?
[CUSTOMER][NEUTRAL] It's 02502639.
[AGENT][NEUTRAL] OK, let me look that up real quick.
[AGENT][NEUTRAL] OK, I do show that Florist does have an active policy. Uh, her effective date is [PII].
[AGENT][NEUTRAL] And this is just to verify benefits. It's not a guarantee of payment. She does have a supplemental insurance policy that is secondary to the primary, and it does help with deductible, co-pay, and co-insurance.
[AGENT][NEUTRAL] She has an inpatient benefit amount of $7900 and an outpatient calendar year benefit amount of $2500.
[CUSTOMER][NEUTRAL] So 2500 it's the maximum that will be covered outpatient.
[AGENT][POSITIVE] Correct, and I can look um and see if she's used anything for you real quick.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][POSITIVE] My love also if you could check for me because last year she had um a benefit for her copay where um it discounted $50 from her copay. I don't know if she still has that now.
[AGENT][POSITIVE] Right, it does help with deductible, co-pay, and co-insurance.
[AGENT][NEUTRAL] And for the.
[AGENT][NEUTRAL] Outpatient benefit for specialist, she has used $200.
[CUSTOMER][NEUTRAL] OK, so she doesn't have that anymore because last time they told me like, for example, to give you an idea of they were like, oh, for 4 visits for a specialist throughout the calendar year we give her um a $50 towards that so they told me that only was for 4 visits.
[AGENT][NEUTRAL] Right.
[AGENT][NEUTRAL] Right. Let me look and see if, um, let me pull up her policy real quick.
[CUSTOMER][POSITIVE] Thank you love.
[AGENT][NEUTRAL] Make sure that nothing's
[AGENT][NEUTRAL] [PII] since you spoke to somebody the last time.
[CUSTOMER][NEUTRAL] Yeah
[AGENT][NEUTRAL] It's gonna be just a sec while I.
[AGENT][NEUTRAL] Pull it in.
[CUSTOMER][NEUTRAL] I would
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Did you
[AGENT][NEUTRAL] Yes, ma'am. What, what was um given to you is still the same. Nothing has been changed on our policy.
[CUSTOMER][NEUTRAL] Yeah, I can
[CUSTOMER][NEUTRAL] OK, so it's still 4 visits, uh, that it's a $50 applied to it, right? for the copay?
[AGENT][NEUTRAL] Right, right, and right, and she's used 200 just for a specialist.
[CUSTOMER][NEUTRAL] OK, does she still have the 4 visits completely left level or has she used any?
[AGENT][NEUTRAL] Um I'm looking to see if she's.
[AGENT][NEUTRAL] So she has 8 visits, um.
[AGENT][NEUTRAL] Per calendar year combined for the family.
[AGENT][NEUTRAL] And it does pay $50 per visit. She's used $200 so a combination of 8 for the family.
[CUSTOMER][NEUTRAL] Oh, OK, so so far you don't see that she's used any of the 8.
[AGENT][NEUTRAL] Let me look, see if it was her that used it.
[AGENT][NEUTRAL] Or if it was a family member.
[CUSTOMER][POSITIVE] OK love
[AGENT][NEUTRAL] Mhm
[AGENT][NEUTRAL] It was her that used it um.
[AGENT][NEUTRAL] Physician office specialist so she's used.
[AGENT][NEUTRAL] 4 of them because she's used $200 so she's used her 4. So right now,
[AGENT][NEUTRAL] Showing for the year of [PII]. Let me look for year [PII] because that's where we are now so it probably starts over again. Yes, it does start over again um [PII].
[AGENT][NEUTRAL] So she does have her visits available.
[CUSTOMER][POSITIVE] OK, so in combination with her family love, yeah, she has 8 in total that she could use.
[AGENT][NEUTRAL] Yes, in combination with the family.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK, love, and you don't see any future termination for this policy, right?
[AGENT][NEUTRAL] No, ma'am, she's current and up to date.
[CUSTOMER][POSITIVE] OK perfect well thank you so much for your help. I highly appreciate it.
[AGENT][POSITIVE] You're so welcome Miss [PII]. I hope you have a blessed new year we appreciate you calling APL today.
[CUSTOMER][POSITIVE] Thank you.
[AGENT][POSITIVE] All right. You take care. Bye-bye.
[CUSTOMER][POSITIVE] Thank you love