AccountId: 011433970860
ContactId: 5256905d-866f-409a-b5c2-142e59e9c66d
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 177940 ms
Total Talk Time (AGENT): 94418 ms
Total Talk Time (CUSTOMER): 46672 ms
Interruptions: 1
Overall Sentiment: AGENT=1.9, CUSTOMER=1.3
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/03/04/5256905d-866f-409a-b5c2-142e59e9c66d_20250304T19:23_UTC.wav
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[AGENT][POSITIVE] Good afternoon. Thank you for calling APL. My name is [PII]. How may I help you?
[CUSTOMER][NEUTRAL] Hi, yes, I'm calling for benefits for outpatient surgery.
[AGENT][POSITIVE] OK, well, I can definitely assist you with the benefits, and may I have your name and a good contact number in case we're disconnected?
[CUSTOMER][NEUTRAL] [PII] [PII].
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] Thank you for that. And [PII], may I have the member's policy number?
[CUSTOMER][NEUTRAL] I have 01599839.
[AGENT][POSITIVE] Thank you. Hold on one moment.
[AGENT][NEUTRAL] And can you verify the member's first and last name and date of birth?
[CUSTOMER][NEUTRAL] [PII] [PII].
[AGENT][NEUTRAL] Thank you for that. And all the information provided is a verification of benefits, not a guarantee of payment. And I am showing the policy is active. It's been um effective since [PII]. And you said outpatient surgery benefit?
[CUSTOMER][NEUTRAL] Yes, uh, yes. [PII]
[AGENT][NEUTRAL] OK, hold on one moment. I'm just waiting for it to come up here.
[CUSTOMER][NEUTRAL] Colonoscopy.
[AGENT][NEUTRAL] OK. So for the outpatient benefit, um, it's up to $500 per occurrence. Um for outpatient, that does include diagnostic testing in a hospital outpatient facility or MRI facility. Um, he also has um the $25 per visit with a max of 4 visits per calendar year for treatment, um, if it is in a
[AGENT][NEUTRAL] Um, physician office, clinic or facility, also the hospital outpatient facility as well.
[CUSTOMER][NEUTRAL] I'm sorry, what was that $25 per?
[AGENT][NEUTRAL] Visit, um, up to 4 visits per calendar year, OK, I'm sorry, I read it right. Up to 4 visits per calendar year.
[CUSTOMER][NEUTRAL] This is per calendar.
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] OK, and has he used any of the 500?
[AGENT][NEUTRAL] Let's see, hold on one moment.
[AGENT][NEGATIVE] Um, so far for [PII], there's been no benefit to you, so he still has, um, the 500.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] And no authorization is required or anything correct?
[AGENT][POSITIVE] Correct.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Um, um, and can I get a reference number for the call?
[AGENT][NEUTRAL] Sure, so there's no call reference number, but you can use my name in today's date. The first initial to my last name is [PII].
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][POSITIVE] All right thank you.
[AGENT][POSITIVE] You're very welcome, [PII]. Was there anything else I can help you with today?
[CUSTOMER][POSITIVE] No, that's it. Thank you.
[AGENT][POSITIVE] Alright, thanks for calling APL. Bye-bye.
[CUSTOMER][POSITIVE] Thank you bye.