AccountId: 011433970860
ContactId: 3d6084fc-3606-4efb-bb3b-61e30ad7866f
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 320510 ms
Total Talk Time (AGENT): 113614 ms
Total Talk Time (CUSTOMER): 44402 ms
Interruptions: 0
Overall Sentiment: AGENT=1.3, CUSTOMER=1.1
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/05/28/3d6084fc-3606-4efb-bb3b-61e30ad7866f_20250528T14:39_UTC.wav
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[AGENT][POSITIVE] Good morning. Thank you for calling APL. My name is [PII]. How may I help you?
[CUSTOMER][NEUTRAL] Hi, I'm calling to get benefits for one of our patients, please.
[AGENT][NEUTRAL] OK, well, I can help you with the benefits and may I have your name and a good contact number?
[CUSTOMER][NEUTRAL] [PII] contact number is [PII].
[AGENT][NEUTRAL] Thank you. And [PII], may I have the member's policy number?
[CUSTOMER][NEUTRAL] It's 1458577 M for Mary, L for Lima 7.
[AGENT][NEUTRAL] Thank you. And can you verify the member's first and last name and date of birth?
[CUSTOMER][NEUTRAL] [PII] [PII].
[AGENT][NEUTRAL] Thank you for that and all the information provided is a verification of benefits, not a guarantee of payment. And I am showing the policy is active. It's been effective since [PII].
[AGENT][NEUTRAL] And what type of benefits are you wanting to go over today?
[CUSTOMER][NEUTRAL] This patient, she's gonna be getting a procedure done in specialist office. I'm not sure if you guys work by CPT codes.
[AGENT][NEUTRAL] We don't, um, but for outpatient, the, um, benefit is up to $4500 per calendar year. Now the policy itself does not have any in-office coverage, but she does have the office treatment rider, um, in which any treatment done in the office could be covered and you know what, let me make, hold on one second because I think she does have some coverage for the visit itself. Hold on one second.
[CUSTOMER][POSITIVE] OK, thank you.
[AGENT][NEUTRAL] I just want to double check this. You're welcome.
[AGENT][NEUTRAL] And [PII], do you mind if I place you on just a brief hold?
[CUSTOMER][POSITIVE] Yeah, that's fine. Thank you.
[AGENT][NEUTRAL] All right. You're welcome. Hold on one moment.
[CUSTOMER][NEGATIVE] You are on hold.
[CUSTOMER][NEGATIVE] You are on hold.
[AGENT][NEUTRAL] Hm.
[CUSTOMER][NEUTRAL] You are on
[AGENT][NEUTRAL] Hello, [PII].
[CUSTOMER][NEUTRAL] Yes, I'm here.
[AGENT][NEUTRAL] All right, thank you so much for holding. I apologize for that wait. So, I did quote you correctly, so the outpatient max is $4500 of that, she has already used $4,301.60. So she, she has $198.40 left for the year.
[AGENT][NEUTRAL] Um, and then for the specialist office to assist with like the facility charge, the policy would pay up to $50 per visit with a max of 4 visits per calendar year.
[CUSTOMER][POSITIVE] OK, perfect. Awesome. Thank you so much.
[AGENT][POSITIVE] You're welcome. Was there anything else I can help you with today?
[CUSTOMER][NEUTRAL] That'll be it if I could just get a reference number please?
[AGENT][NEUTRAL] Sure, so there's no call reference number, but you can use my name in today's date. And again, that's [PII], first initial to my last name is [PII].
[CUSTOMER][POSITIVE] Awesome thank you for your help.
[AGENT][POSITIVE] You're welcome, [PII]. Thanks for calling APL. I hope you have a good day.
[CUSTOMER][POSITIVE] You too. Thank you.
[AGENT][POSITIVE] Thank you. You're welcome. Bye bye.
[CUSTOMER][NEUTRAL] Bye.