AccountId: 011433970860
ContactId: 49f1f09d-3194-4b58-b064-1bff6db8e52b
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 185360 ms
Total Talk Time (AGENT): 97056 ms
Total Talk Time (CUSTOMER): 78408 ms
Interruptions: 0
Overall Sentiment: AGENT=1.2, CUSTOMER=0.3
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/06/04/49f1f09d-3194-4b58-b064-1bff6db8e52b_20250604T15:54_UTC.wav
--------------------------------------------
[AGENT][POSITIVE] Good morning. Thank you for calling ATL. This is [PII]. How may I assist you?
[CUSTOMER][NEUTRAL] Hi, good morning. I'm calling from a provider's office trying to get um benefits on a member, please.
[AGENT][POSITIVE] OK, sure, I can assist you with benefits. May I have your name and a callback number just in case we get disconnected?
[CUSTOMER][NEUTRAL] [PII], [PII].
[AGENT][NEUTRAL] And what's the name of the office?
[CUSTOMER][NEUTRAL] Wellness Health Miami.
[AGENT][NEUTRAL] Thank you. And may I have the patient's policy number, Miss [PII]?
[CUSTOMER][NEUTRAL] 02258742 M.
[CUSTOMER][NEUTRAL] 17.
[CUSTOMER][NEUTRAL] Or might be L7.
[AGENT][NEUTRAL] Mm.
[CUSTOMER][NEUTRAL] Hm.
[AGENT][NEUTRAL] It's OK, no problem. We don't need anything after the the um.
[CUSTOMER][NEUTRAL] I think it's ML 7. OK.
[AGENT][NEUTRAL] Mhm. Yeah, it's fine. Thank you. And may I have the name and date of birth of the patient?
[CUSTOMER][NEUTRAL] [PII]. Date of birth is [PII].
[AGENT][POSITIVE] Perfect, thank you. All right, and you said you need benefits and let's see what we have.
[CUSTOMER][NEGATIVE] Yeah, so the last time that I called on [PII], I was told um the effective date, which was [PII]. The plan does not cover any office visits. It does cover hospital only and the maximum coverage was 2500. I just want to know the accumulations.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] OK, and this is not a guarantee of payment, just a verification of coverage. Now Miss [PII], this particular policy doesn't cover the office visit, but it does cover office procedures. So if there's any procedures done in office, there is a benefit under the outpatient maximum which is 1500 for outpatient service per year. And then you have the inpatient, which is the 2500 per year for the inpatient, OK?
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Mm.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] OK. And has anything been applied to?
[AGENT][NEUTRAL] All right, so let me check.
[AGENT][NEUTRAL] Yeah, let me check and see what's the remaining balance on the outpatient and inpatient. OK, one moment.
[CUSTOMER][NEUTRAL] I
[CUSTOMER][POSITIVE] Thank you so much.
[AGENT][NEUTRAL] You're welcome. OK, so it looks like as of today they have not used their benefits for [PII], so they still have the full amount available.
[CUSTOMER][NEUTRAL] OK. And may I have a reference number for this call?
[AGENT][NEUTRAL] We don't have reference numbers. You can use my name in today's date if you will. Do you need the spelling of my name or any other information, Miss [PII]?
[CUSTOMER][NEUTRAL] Yes, just the spelling of your name, please.
[AGENT][NEUTRAL] Mhm. Sure. The spelling is [PII]. Last initial is [PII].
[CUSTOMER][POSITIVE] OK, thank you. Have a nice day.
[AGENT][NEUTRAL] You're welcome. You asked on this. [PII] again. Thank you for calling APL.