AccountId: 011433970860
ContactId: 3f937e46-4979-40b3-a8e8-f04522f4fa5f
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 262048 ms
Total Talk Time (AGENT): 95050 ms
Total Talk Time (CUSTOMER): 86084 ms
Interruptions: 3
Overall Sentiment: AGENT=1, CUSTOMER=0.3
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/01/31/3f937e46-4979-40b3-a8e8-f04522f4fa5f_20250131T15:29_UTC.wav
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[AGENT][NEUTRAL] Thank you for calling APL. This is [PII]. How may I help you?
[CUSTOMER][NEUTRAL] Hello [PII], my name is [PII]. That is spelled [PII] How would you spell your name?
[AGENT][NEUTRAL] [PII]
[CUSTOMER][NEUTRAL] I
[CUSTOMER][POSITIVE] Thank you, [PII].
[AGENT][POSITIVE] You're welcome.
[AGENT][NEUTRAL] So [PII], how can I help you today?
[CUSTOMER][NEUTRAL] So yeah, the reason for this call is because I'm calling from uh uh provider's office just calling for members eligibility and benefits.
[AGENT][POSITIVE] OK, I can help you with eligibility and benefits. Can you please give me your callback number just in case our call is disconnected?
[CUSTOMER][NEUTRAL] I
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Yeah, [PII].
[AGENT][NEUTRAL] Thank you, sir. And then what is the patient's name?
[CUSTOMER][NEUTRAL] I have here [PII].
[CUSTOMER][NEUTRAL] And then the date of birth is [PII].
[AGENT][NEUTRAL] OK. And then what is the patient's policy number?
[CUSTOMER][NEUTRAL] 02286477 M as in Mike L as in Larry and the number 8.
[AGENT][NEUTRAL] OK, let me pull that policy up for us real quick.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] OK, I do show that [PII] does have an active policy. Her effective date is [PII].
[CUSTOMER][NEUTRAL] February this higher so I have it after.
[AGENT][NEUTRAL] And this is just to verify her coverage. It's not a guarantee of payment.
[CUSTOMER][NEUTRAL] Yeah mhm.
[AGENT][NEUTRAL] She has a supplemental insurance policy that is billed secondary to the primary. It's a gap insurance that helps with deductible, co-pay, and co-insurance.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Mhm OK.
[AGENT][NEUTRAL] She has a she has an inpatient benefit amount of $6350 per calendar year and then she has an outpatient per calendar day amount of $500.
[CUSTOMER][NEUTRAL] Yeah
[CUSTOMER][NEUTRAL] and um.
[CUSTOMER][NEUTRAL] Will I be the.
[CUSTOMER][NEUTRAL] Alright, so my my mom does it cover primary care office visits?
[AGENT][NEUTRAL] Uh, let me look and see.
[CUSTOMER][NEUTRAL] Yeah
[CUSTOMER][NEUTRAL] Right now, OK.
[AGENT][NEUTRAL] I'm going to need to pull in the policy real quick so that I can read it.
[CUSTOMER][NEUTRAL] Go ahead.
[CUSTOMER][NEUTRAL] Yeah
[AGENT][NEUTRAL] OK, it's pulling in now so I'm gonna look for the office visits to see if it's covered.
[CUSTOMER][NEUTRAL] About
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] OK. It does not cover office visits. It does cover for ER urgent care center, MRI imaging center or an ambulatory center.
[CUSTOMER][NEUTRAL] Um well.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Yeah
[CUSTOMER][NEUTRAL] OK, so it does not cover office visit.
[AGENT][POSITIVE] Correct.
[CUSTOMER][NEUTRAL] OK, so
[CUSTOMER][NEUTRAL] Uh.
[CUSTOMER][NEUTRAL] OK, all I would need now is a reference number and I'll be on my way to her.
[AGENT][NEUTRAL] Yes, sir. You can use my name and today's date.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][POSITIVE] Thank you Ty.
[AGENT][POSITIVE] You're very welcome. Thanks for calling APL walking. I hope you have a great weekend.
[CUSTOMER][NEUTRAL] You as well.
[AGENT][NEUTRAL] Bye-bye, sir.
[CUSTOMER][NEUTRAL] Bye.