AccountId: 011433970860
ContactId: 4875bb7c-23a7-4238-907c-d5d34ad0b2b1
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 201279 ms
Total Talk Time (AGENT): 94389 ms
Total Talk Time (CUSTOMER): 58011 ms
Interruptions: 0
Overall Sentiment: AGENT=0.6, CUSTOMER=1.1
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/05/08/4875bb7c-23a7-4238-907c-d5d34ad0b2b1_20250508T17:51_UTC.wav
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[AGENT][NEUTRAL] Thank you for calling APL. This is [PII]. How can I help you?
[CUSTOMER][NEUTRAL] Thank you, my name is [PII]. I'm calling from the doctor's office. I need to check benefits and eligibility for a specialist office visit, please.
[AGENT][NEUTRAL] OK.
[AGENT][POSITIVE] Sure, I can check eligibility and benefits for you. Uh, [PII], can I get a good call back number from you first in case we're disconnected?
[CUSTOMER][NEUTRAL] [PII].
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] OK, thank you. And do you have that policy number?
[CUSTOMER][NEUTRAL] It's 02486292.
[CUSTOMER][NEUTRAL] [PII] 7656.
[AGENT][NEUTRAL] Perfect, thank you so much for verifying that, [PII]. Uh, so this policy is active. Effective date was [PII], and this is a secondary medical policy, so it is designed to help with co-pay, deductible and co-insurance after major medical pays, and you did say that you were looking specifically for a specialist office visit, is that correct?
[CUSTOMER][NEUTRAL] So
[CUSTOMER][NEUTRAL] Office visit and procedures on an office setting.
[AGENT][NEUTRAL] Got you. OK, and of course I will let you know verification of coverage is not a guarantee of payment for claims. So under this policy office visits are not going to be covered, um, but you also said, uh some treatment in office could be, um, let's see.
[CUSTOMER][NEUTRAL] like
[AGENT][NEUTRAL] Yes, OK, so office visits are not covered, uh, however treatment received in office could be.
[CUSTOMER][NEUTRAL] OK, thank you and the amount that is that the member has for benefits?
[AGENT][NEUTRAL] For outpatient, let me check that outpatient benefit.
[AGENT][NEUTRAL] That is $5000 max per calendar year and if you'll give me one moment I'll go ahead and see if any of that has been used.
[CUSTOMER][POSITIVE] OK, thank you.
[AGENT][NEUTRAL] All right, one moment.
[AGENT][NEUTRAL] OK. Sorry, he has used quite a bit, so bear with me just a moment.
[AGENT][NEUTRAL] So of that benefit he has used $4280.05.
[CUSTOMER][NEUTRAL] Uh huh, for that 800.
[AGENT][NEUTRAL] No, ma'am.
[CUSTOMER][NEUTRAL] Or 200.
[AGENT][NEUTRAL] $4280.05 yes.
[CUSTOMER][NEUTRAL] I'm 80.
[CUSTOMER][POSITIVE] Perfect perfect perfect thank you so much for your help I appreciate it.
[AGENT][NEUTRAL] Of course, was there anything else I could help you with?
[CUSTOMER][POSITIVE] No, have a nice day.
[AGENT][POSITIVE] Alright, yeah, thanks for calling APL you too bye bye.
[CUSTOMER][NEUTRAL] Bye bye.
[CUSTOMER][NEUTRAL] Yeah