AccountId: 011433970860
ContactId: 422994b6-d4ff-4f87-baef-034ac103ea73
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 314670 ms
Total Talk Time (AGENT): 126989 ms
Total Talk Time (CUSTOMER): 88068 ms
Interruptions: 0
Overall Sentiment: AGENT=1.1, CUSTOMER=0
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/02/26/422994b6-d4ff-4f87-baef-034ac103ea73_20250226T14:21_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] Yes calling for benefit information.
[AGENT][POSITIVE] OK, I can help you with the benefits. May I have your name and a good contact number?
[CUSTOMER][NEUTRAL] My name is [PII] telephone number [PII].
[AGENT][NEUTRAL] Thank you for that. And may I have the member's policy number?
[CUSTOMER][NEUTRAL] 01261895 M as in Michael L as in Lima 8.
[AGENT][NEUTRAL] Thank you for that. And can you verify the member's first and last name and date of birth?
[CUSTOMER][NEUTRAL] [PII]. Date of birth is [PII].
[AGENT][NEUTRAL] Thank you for that and all the information provided is a verification of benefits, not a guarantee of payment. So I am showing the policy is active. It's been effective since [PII]. And what type of um benefit information did you need?
[CUSTOMER][NEUTRAL] Um, he's at the specialist doctor's office and he's gonna have X-rays done.
[CUSTOMER][NEUTRAL] And a possible minor procedure.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] So let me see.
[AGENT][NEUTRAL] X-ray.
[AGENT][NEUTRAL] And
[AGENT][NEUTRAL] And you said a physician office or specialist office?
[CUSTOMER][NEUTRAL] Specialists
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] And do you mind if I place you on just a brief hold while I go through the benefits?
[CUSTOMER][POSITIVE] No problem.
[AGENT][NEUTRAL] All right, hold on one moment.
[CUSTOMER][NEUTRAL] OK
[CUSTOMER][NEGATIVE] You are on hold.
[AGENT][NEUTRAL] Cause I'm gonna have to pull this up and I don't want to have to hold, I mean, wait.
[AGENT][NEUTRAL] Uh.
[AGENT][NEUTRAL] Yeah.
[AGENT][NEUTRAL] Come on.
[CUSTOMER][NEGATIVE] You are on hold.
[AGENT][NEUTRAL] Hello.
[CUSTOMER][NEUTRAL] Yeah hi
[AGENT][POSITIVE] Thank you so much for holding. I apologize for that wait. So for outpatient, the calendar year max is 1000 up to $1000 per person per um calendar year. They also have the specialist office visit fee, which pays up to $50 per visit with a max of $4 per calendar year per person.
[CUSTOMER][NEUTRAL] So you pay up to $50 for the visit.
[CUSTOMER][NEUTRAL] And and you said how many per year? 4?
[AGENT][NEUTRAL] Yes. Mhm.
[CUSTOMER][NEUTRAL] Has he, has he met any of those?
[AGENT][NEGATIVE] So far, not for 2025. None of the benefits have been used yet.
[CUSTOMER][NEUTRAL] OK, and what about like X-rays and all that?
[AGENT][NEUTRAL] So depending on the um coding, it can either be under diagnostic testing, which would be up to that $1000 per calendar year. um, and then the fee itself, it would take off one of those visits if it's in the specialist office, but if it's all together, then that would just be one visit.
[CUSTOMER][NEUTRAL] OK, so he's having a visit and he's getting diagnostic X-rays.
[CUSTOMER][NEUTRAL] So your company pays up to $50 for the visit?
[AGENT][POSITIVE] Correct. Mhm.
[CUSTOMER][NEUTRAL] Correct. And then what about the X-ray? I'm confused.
[AGENT][NEUTRAL] So the, so the total for the outpatient is $1000. So what whatever is billed for that day, it'll just be up to that $1000 per calendar year. So,
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] OK, it's only gonna be like, you know, $100 so you, you would pay the $100?
[AGENT][NEUTRAL] So we pay towards the copay, the deductible and co-insurance of covered charges after primary.
[CUSTOMER][NEUTRAL] Oh, OK.
[AGENT][NEUTRAL] Up to the calendar year max.
[CUSTOMER][NEUTRAL] You pay the copay, deductible and co-in interest up to $1000 OK.
[CUSTOMER][NEUTRAL] Alright, it's a little confusing.
[CUSTOMER][NEUTRAL] Um, OK, can I get a reference number?
[AGENT][NEUTRAL] Sure, so there's no call reference number, but you can use my name in today's date. The first initial to my last name is [PII].
[CUSTOMER][NEUTRAL] What's your first name? I'm sorry.
[AGENT][NEUTRAL] [PII]
[CUSTOMER][POSITIVE] [PII] OK, alright, [PII], thank you so much for your help.
[AGENT][POSITIVE] You're welcome. Was there anything else I can help with?
[CUSTOMER][NEUTRAL] No, that's it.
[AGENT][POSITIVE] Alright, thanks for calling APL.
[CUSTOMER][POSITIVE] Thank you bye.
[AGENT][NEUTRAL] Bye bye.