AccountId: 011433970860
ContactId: 4559c8d8-c13a-4060-9113-6a75cf3b6e03
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 163320 ms
Total Talk Time (AGENT): 67321 ms
Total Talk Time (CUSTOMER): 63136 ms
Interruptions: 1
Overall Sentiment: AGENT=1.4, CUSTOMER=0.6
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/03/20/4559c8d8-c13a-4060-9113-6a75cf3b6e03_20250320T21:54_UTC.wav
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[AGENT][NEUTRAL] Calling APL, my name is [PII]. How can I assist you today?
[CUSTOMER][NEUTRAL] Hi [PII], I'm calling for benefits on a patient.
[AGENT][POSITIVE] I'll be happy to assist with benefits. May I have your first name, please?
[CUSTOMER][NEUTRAL] [PII]
[AGENT][NEUTRAL] [PII], if I can get a good callback number for you?
[CUSTOMER][NEUTRAL] [PII]
[AGENT][NEUTRAL] And what is the policy number?
[CUSTOMER][NEUTRAL] Um, policy number is going to be.
[CUSTOMER][NEUTRAL] 1935525 M as in Mary, L as in Lima and the number 8.
[AGENT][NEUTRAL] Patient's name and date of birth?
[CUSTOMER][NEUTRAL] [PII] [PII].
[AGENT][POSITIVE] Thank you for that information.
[AGENT][NEUTRAL] Please be advised the verification of coverage is not a guarantee of payment. I do show the policy is currently active. Effective date is [PII], and are you calling for inpatient or outpatient benefits?
[CUSTOMER][NEUTRAL] Uh
[CUSTOMER][NEUTRAL] Outpatient?
[AGENT][NEUTRAL] I do show the outpatient per occurrence is $500.
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] OK
[CUSTOMER][NEUTRAL] $500 per month or per calendar year?
[AGENT][NEUTRAL] Per occurrence.
[CUSTOMER][NEUTRAL] Or per day?
[AGENT][NEUTRAL] Per occurrence.
[CUSTOMER][NEUTRAL] Per occurrence. OK, so every time they have an outpatient procedure outpatient um.
[AGENT][NEUTRAL] Mhm
[CUSTOMER][NEUTRAL] Appointment
[AGENT][NEUTRAL] So, if it's for the same diagnosis, he would have to wait a 90, a 90-day period. But if it's a different diagnosis, then yes, it would be 500 per occurrence.
[CUSTOMER][NEUTRAL] For the same.
[CUSTOMER][NEUTRAL] OK, um, and has anything been used?
[AGENT][NEUTRAL] No.
[CUSTOMER][NEUTRAL] OK, so I, that, that means that he hasn't had any occurrences or corrupt.
[AGENT][POSITIVE] Correct.
[CUSTOMER][NEUTRAL] Um,
[CUSTOMER][NEUTRAL] And then no authorization is required, right?
[AGENT][NEUTRAL] No.
[CUSTOMER][NEUTRAL] OK, perfect. Do you guys give reference numbers?
[AGENT][NEUTRAL] Reference would just be my name [PII], last initial S as in [PII], and the date and time of the call. Was there anything else I could assist with today?
[CUSTOMER][NEUTRAL] Is there a group name and number?
[AGENT][NEUTRAL] One moment.
[AGENT][NEUTRAL] The group number I'm showing is 14,640. Group name is Homestead Paving Company.
[CUSTOMER][NEUTRAL] OK, and then you said um if it's the same diagnosis for, for the occurrence, you have to wait 90 days, right?
[AGENT][POSITIVE] That's correct.
[CUSTOMER][POSITIVE] OK perfect thank you so much.
[AGENT][POSITIVE] Thank you for calling APL you have a good day.
[CUSTOMER][POSITIVE] Have a good day bye bye.