AccountId: 011433970860
ContactId: 518cd8d7-f64f-442c-8dca-086812f285b0
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 261428 ms
Total Talk Time (AGENT): 105613 ms
Total Talk Time (CUSTOMER): 51339 ms
Interruptions: 0
Overall Sentiment: AGENT=1.2, CUSTOMER=0.4
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/06/23/518cd8d7-f64f-442c-8dca-086812f285b0_20250623T16:18_UTC.wav
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[AGENT][NEUTRAL] Thank you for calling APL. This is [PII]. How can I help you?
[AGENT][NEUTRAL] Thank you for calling APL. This is [PII]. How can I help you?
[CUSTOMER][NEUTRAL] Hey, hi, [PII]. My name is [PII].
[CUSTOMER][NEUTRAL] I'm calling you from doctor's office. I wanted to check eligibility and benefits for a member for specialist office visit and X-ray.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] I'm sorry, did you say office visit?
[CUSTOMER][NEUTRAL] Yeah, specialist office visit and X-ray.
[AGENT][POSITIVE] OK, I can check those benefits for you. [PII], can I get a good call back number from you first in case we're disconnected please?
[CUSTOMER][NEUTRAL] Yeah. The callback number is [PII], and it's a direct line.
[AGENT][NEUTRAL] OK thank you and then do you have that policy number?
[CUSTOMER][NEUTRAL] Yes.
[CUSTOMER][NEUTRAL] The policy number is 01780461.
[AGENT][NEUTRAL] OK, thank you and then what was the name and date of birth for the member please?
[CUSTOMER][NEUTRAL] The name of the member is [PII], and the date of birth is [PII].
[AGENT][POSITIVE] Perfect, thank you for verifying that. And 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. If you'll give me one moment, I will double check uh those benefits to see if office visits are covered.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Yeah, I have the CPT codes.
[AGENT][NEUTRAL] Uh, one moment, let me get that policy pulled up. I'm unable to check with CBT codes. Some of these, uh, policies offer uh coverage in office settings, and some of them do not. So let me first verify that information.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] OK, I appreciate your patience and of course I will let you know verification of coverage is not a guarantee of payment for claims. So for this policy, office visits and treatment received in office are not covered.
[CUSTOMER][NEUTRAL] Uh, for both, uh, office visit and X-ray?
[AGENT][NEUTRAL] Of visits and then treatment received in office are not going to be covered. They have coverage for uh emergency room, urgent care, uh, surgical benefits, um, in an outpatient facility or a surgical center, diagnostic testing in an outpatient facility or MRI facility, but nothing in an office setting.
[CUSTOMER][NEUTRAL] OK. Can you help me with the call reference number?
[AGENT][NEUTRAL] Reference number would be my first name, last initial, and today's date. And so my name is spelled [PII] last initial is [PII] And was there anything else I could help you with?
[CUSTOMER][POSITIVE] No, uh, thank you for your help and assistance, [PII]. Have a great day.
[AGENT][POSITIVE] Of course, thanks for calling APL you too bye bye.
[CUSTOMER][NEUTRAL] Mhm.