AccountId: 011433970860
ContactId: 44c46db0-2b91-4216-9e3e-6fd16d55dec4
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 259750 ms
Total Talk Time (AGENT): 95251 ms
Total Talk Time (CUSTOMER): 120029 ms
Interruptions: 0
Overall Sentiment: AGENT=0.6, CUSTOMER=1.6
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/03/21/44c46db0-2b91-4216-9e3e-6fd16d55dec4_20250321T12:03_UTC.wav
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[AGENT][NEUTRAL] Thank you for calling APL. This is [PII]. How may I help you?
[CUSTOMER][NEUTRAL] Good morning, [PII]. My name is [PII]. I'm calling for um benefits for a patient we have in common.
[AGENT][NEUTRAL] OK, is this for service in a doctor's office?
[CUSTOMER][NEUTRAL] Yes, I'm calling from the doctor's office.
[AGENT][NEUTRAL] OK, what's the policy number and a good phone number in case we're disconnected?
[CUSTOMER][NEUTRAL] The phone number will be [PII] and it is a direct line and the policy number of the patient is 02416803 M as in Mike L as in Lima and number 7.
[AGENT][NEUTRAL] Uh-huh.
[AGENT][POSITIVE] Thank you.
[CUSTOMER][POSITIVE] Thanks to you, [PII].
[AGENT][NEUTRAL] And the patient's name and date of birth.
[CUSTOMER][NEUTRAL] It is, give me one second.
[CUSTOMER][NEUTRAL] Oh
[CUSTOMER][NEUTRAL] The patient's name is
[CUSTOMER][NEUTRAL] It's [PII]. Um, the date of birth is [PII].
[AGENT][NEUTRAL] OK, thank you for verifying that information, [PII]. Um, so we're checking eligibility and then benefits for service in a doctor's office. We have that information for you showing an effective date of [PII]. This policy is active at this time.
[AGENT][NEUTRAL] And under this policy.
[AGENT][NEUTRAL] Uh, service in a doctor's office is not, uh, covered. Do you know what the chief complaint is or the diagnosis code?
[CUSTOMER][NEUTRAL] Yes, I have a technois called. Uh, give me one second.
[CUSTOMER][NEUTRAL] I would like to know um if um outpatient diagnostic services are covered by you guys?
[AGENT][NEUTRAL] So if it's in an outpatient diagnostic facility, there is an outpatient benefit under the policy. Did you want that benefit?
[CUSTOMER][NEUTRAL] Yes, please.
[AGENT][NEUTRAL] OK, so the maximum outpatient benefit is up to $2500 per calendar year and any information provided is verification, not a guarantee of payment.
[AGENT][NEUTRAL] And did you know what the chief complaint is for the service?
[CUSTOMER][NEUTRAL] Yes. Give me 1 2nd, please.
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] It is N as in Nancy, 39.46.
[CUSTOMER][NEUTRAL] That's the latest, the latest one that I have.
[AGENT][NEUTRAL] OK, OK, OK, alright, so the physician's visit, uh, fee and then treatment in the office is not covered under this policy, but outpatient yes.
[CUSTOMER][NEUTRAL] OK. Just give me one second. Do you pick up all the deductible, the co-insurance, and the copays for the primary?
[AGENT][NEUTRAL] Correct, of covered charges of the primary insurance, yes.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Um, so the office visit is not covered by you.
[AGENT][POSITIVE] Correct.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] The patient has um met any of the 2500.
[AGENT][NEUTRAL] Prescriptions.
[AGENT][NEUTRAL] The benefit? Are you back to the benefit?
[CUSTOMER][NEUTRAL] Yes, the um, the patient has uh made something, uh, for, of that $2500.
[AGENT][NEUTRAL] Oh, have any of that been used? OK, let me check that for you.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] Not at this time.
[CUSTOMER][NEUTRAL] OK, so, OK.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] Any other questions?
[CUSTOMER][NEUTRAL] Uh, no, just to recap, the patient is active with you guys since, um, [PII], and you are covered, um, outpatient diagnostic services are covered up to $2500. Even the patient hasn't met anything so far and you pick up all the deductible, the and the copays and the office visit is not covered by you.
[AGENT][NEUTRAL] Correct, and the deductible co-insurance and co-pay amount of covered charges, and that is correct.
[CUSTOMER][POSITIVE] Oh, OK. Thank you so much. Uh, please may I have um a call reference number?
[AGENT][NEUTRAL] My name in today's date, [PII]. Any other questions?
[CUSTOMER][POSITIVE] No, thank you so much.
[AGENT][POSITIVE] You're welcome thank you for calling APL. Have a, have a good day.
[CUSTOMER][POSITIVE] Thank you so much.
[CUSTOMER][POSITIVE] Thank you.
[CUSTOMER][NEUTRAL] You too. Bye-bye.