AccountId: 011433970860
ContactId: 488f5784-ce53-4ac0-975d-ab52dd8c9a2d
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 190830 ms
Total Talk Time (AGENT): 93048 ms
Total Talk Time (CUSTOMER): 86364 ms
Interruptions: 1
Overall Sentiment: AGENT=1.4, CUSTOMER=2
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/05/29/488f5784-ce53-4ac0-975d-ab52dd8c9a2d_20250529T14:22_UTC.wav
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[AGENT][POSITIVE] Good morning. Thank you for calling APO. This is [PII]. May I help you?
[CUSTOMER][NEUTRAL] Hi, good morning. My name is [PII]. I'm calling from a physician office to verify patients benefits.
[AGENT][POSITIVE] OK, I can verify benefits for you and I apologize, your name is again?
[CUSTOMER][NEUTRAL] [PII]
[AGENT][NEUTRAL] Oh
[AGENT][POSITIVE] YES [PII] Thank you. And what is that policy number, Miss [PII]?
[CUSTOMER][NEUTRAL] 02507921 ML 8.
[AGENT][NEUTRAL] OK, thank you. And do you have a callback number in case the call drops?
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] OK. And the patient's name, date of birth?
[CUSTOMER][NEUTRAL] [PII] [PII].
[AGENT][NEUTRAL] OK. Uh, so her effective date is [PII]. She is active on the policy. And what benefits are needing for this patient?
[CUSTOMER][NEUTRAL] Uh, like for outpatient benefits like office visit or ultrasound surgical procedure done in office if it's covered.
[AGENT][NEUTRAL] Uh, it's not covered. No, ma'am. Uh, with this policy, it only covers services in an outpatient facility like ER, urgent care, ambulatory surgery center, MRI or imaging center, or if they were confined as inpatient in the hospital.
[CUSTOMER][NEUTRAL] You want
[CUSTOMER][NEUTRAL] Alright, so she have only covered for hospital basically, right? Not for office.
[AGENT][POSITIVE] Correct, yes, ma'am.
[CUSTOMER][POSITIVE] OK perfect thank you so let me just get um.
[CUSTOMER][NEUTRAL] Um, the reference number and up to how much would be in case that she has a surgery in the hospital to how much would be covered.
[AGENT][NEUTRAL] So you're wanting inpatient visits?
[CUSTOMER][NEUTRAL] Uh, let's say I mean if it's done in office, if it's outpatient, should we be covered as well or only if it's inpatient?
[AGENT][NEUTRAL] Um, it was not covered in office, but outpatient is covered.
[CUSTOMER][NEUTRAL] No, no, no, on hospital, hospital. Yeah, no, I'm saying hospital and in case that she has a surgery done in office, let's say, up to how much would be covered.
[AGENT][NEUTRAL] Mhm.
[AGENT][NEUTRAL] Nothing because it doesn't cover any procedures in office. That's what I'm saying outpatient, like if she had to go to a surgery center or if you're saying that she's having surgery, is she gonna be inpatient you believe or is this gonna be outpatient?
[CUSTOMER][NEUTRAL] No, I'm saying yeah.
[CUSTOMER][NEUTRAL] That's what I'm saying.
[CUSTOMER][NEUTRAL] Yes
[CUSTOMER][NEUTRAL] Outpatient but in hospital do you know that sometimes they have like surgery in hospital but she doesn't have to stay in the hospital.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] OK, yes ma'am. OK, um, not a guarantee of payment, just verification of coverage.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] For outpatients, she has a benefit max of 3500 per calendar year.
[CUSTOMER][POSITIVE] OK, so 3500. OK, perfect, thank you so much. Let me get your name.
[AGENT][NEUTRAL] Yes, ma'am.
[AGENT][NEUTRAL] It's [PII], last initial [PII].
[CUSTOMER][POSITIVE] Great thank you so much that will be the reference, right?
[AGENT][NEUTRAL] Uh, yes, ma'am.
[CUSTOMER][POSITIVE] Great thank you so much you you have a nice day.
[AGENT][POSITIVE] Uh, you too, Miss [PII] thanks for calling APL.
[CUSTOMER][POSITIVE] Thank you.