AccountId: 011433970860
ContactId: 4b660368-7736-463b-9cc0-f2acd5753094
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 267299 ms
Total Talk Time (AGENT): 134594 ms
Total Talk Time (CUSTOMER): 89587 ms
Interruptions: 1
Overall Sentiment: AGENT=0.4, CUSTOMER=1
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/03/13/4b660368-7736-463b-9cc0-f2acd5753094_20250313T19:16_UTC.wav
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[AGENT][NEUTRAL] Afternoon thank you for calling APL this is how may I assist you?
[CUSTOMER][NEUTRAL] Uh, so I'm calling to confirm this patient's gap insurance with you guys, if they have an outpatient dollar amount for the year and any restrictions for ultrasound?
[AGENT][NEUTRAL] Hm
[AGENT][NEUTRAL] Mhm.
[AGENT][NEUTRAL] Mhm
[AGENT][NEUTRAL] Ultrasound. Um, OK. Um, may I have your name and a callback number just in case we get disconnected?
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Yes, [PII] sorry, first name is [PII].
[CUSTOMER][NEUTRAL] Callback number [PII].
[AGENT][NEUTRAL] Mhm.
[AGENT][NEUTRAL] OK, and you're calling from which facility from my location?
[CUSTOMER][NEUTRAL] West Kendal Baptist Hospital?
[AGENT][POSITIVE] Hospital. OK, perfect.
[AGENT][NEUTRAL] All right, and you said you need eligibility and benefits. May I have the patient's policy number, Miss [PII]?
[CUSTOMER][NEUTRAL] Sure, that is 02565958 is what I have.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] And what's the name and date of birth of the patient?
[CUSTOMER][NEUTRAL] [PII], [PII].
[AGENT][NEUTRAL] OK, thank you. And before I give you any benefit information, I need to let you know that this is not a guaranteed payment, just a verification of coverage and that's just a disclaimer. And we have an effective date of [PII]. It is active at the moment and this is one of our secondary supplemental plans to the major medical.
[CUSTOMER][POSITIVE] Wow.
[AGENT][NEUTRAL] And we have an outpatient.
[CUSTOMER][NEUTRAL] You said [PII]. I'm sorry.
[AGENT][NEUTRAL] Mm
[AGENT][NEUTRAL] Yes, [PII]. Mhm.
[CUSTOMER][NEUTRAL] OK, got it. OK.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] Um, bear with me just a second. I put that out.
[CUSTOMER][NEUTRAL] You said it is one of the major medicals. OK. Go ahead.
[AGENT][NEUTRAL] This is secondary. This is a secondary to the major medical.
[CUSTOMER][NEUTRAL] So
[AGENT][NEUTRAL] Yeah, supplemental plan.
[CUSTOMER][NEUTRAL] Right, secondary, do they have outpatient dollar amount for the year and have they used anything so far?
[AGENT][NEUTRAL] Mhm.
[AGENT][NEUTRAL] Mhm.
[AGENT][NEUTRAL] Let me check on that. OK, so we have an outpatient maximum of 8500 per cover person per calendar year. And let me check and see how much he has used. And you said that the um ultrasound is gonna take place in a hospital, correct?
[CUSTOMER][NEUTRAL] Yes, outpatient hospital, correct.
[AGENT][NEUTRAL] Uh
[AGENT][NEUTRAL] OK. All right.
[AGENT][NEUTRAL] OK, let's see.
[AGENT][NEUTRAL] OK, and as of today, he has not used his benefits for [PII], so he still have the full amount available.
[CUSTOMER][NEUTRAL] 0. OK, perfect. So in this case, does he have any group name, group number associated with this policy?
[AGENT][NEUTRAL] Mhm, yeah, let me get that for you, one moment.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] OK, the group name is
[AGENT][NEUTRAL] That's Mercedes management.
[CUSTOMER][NEUTRAL] Mm, can you spell that for me? Just to make sure I spell it correctly.
[AGENT][NEUTRAL] Um, the first word is last, which is L A S. The second word missed, which is [PII] E R C E D E S.
[CUSTOMER][NEUTRAL] So.
[AGENT][NEUTRAL] And the third word is management, M A N A G E M E N T.
[CUSTOMER][POSITIVE] Perfect. OK. OK.
[AGENT][NEUTRAL] OK, and the group number is 21254.
[CUSTOMER][NEUTRAL] 21254.
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Got it, perfect. And then the PO box for claims, I have [PII], [PII] City, [PII]. Is that correct?
[AGENT][POSITIVE] That is correct, yes.
[CUSTOMER][NEUTRAL] OK, [PII]. Perfect. Alright, that's all I have for you today. So can I have a call reference number for the call and the first initial of your last name?
[AGENT][NEUTRAL] Mhm.
[AGENT][NEUTRAL] We don't have, we don't have reference numbers. You can use my name in today's date. The last initial is [PII].
[CUSTOMER][POSITIVE] Perfect. All right, thank you so. I hope you enjoy the rest of your day.
[AGENT][POSITIVE] You're welcome. You sir, and thank you for calling ATM. bye-bye. You're welcome.
[CUSTOMER][POSITIVE] Thank you bye.