AccountId: 011433970860
ContactId: 548b6e0b-e889-46c9-b22e-f9140d8aafb1
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 423549 ms
Total Talk Time (AGENT): 118576 ms
Total Talk Time (CUSTOMER): 66900 ms
Interruptions: 0
Overall Sentiment: AGENT=0.8, CUSTOMER=0.4
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/04/22/548b6e0b-e889-46c9-b22e-f9140d8aafb1_20250422T20:18_UTC.wav
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[AGENT][NEUTRAL] Thank you for calling APL. This is [PII]. How may I help you?
[CUSTOMER][NEUTRAL] Yes, my name is [PII]. I'm calling from the neurology clinics of North Texas, and I'm trying to verify benefits on a patient.
[AGENT][NEUTRAL] Yeah, of course.
[AGENT][NEUTRAL] I can help you with benefits today. Do you have the policy number?
[CUSTOMER][NEUTRAL] I have 02212270.
[AGENT][POSITIVE] OK, perfect.
[AGENT][NEUTRAL] And then what's a good callback number in case our call gets dropped?
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] OK. And then the patient's first and last name and date of birth, please?
[CUSTOMER][NEUTRAL] [PII] [PII].
[AGENT][NEUTRAL] Yeah.
[AGENT][NEUTRAL] OK, so it looks like the policy number you gave me is no longer active.
[AGENT][NEUTRAL] Mhm.
[AGENT][NEUTRAL] So it looks like it turned 901-2024. Let me check if he has any more policies.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEGATIVE] You're lying.
[CUSTOMER][NEUTRAL] We.
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] Let
[AGENT][NEUTRAL] OK and then is this for an office visit?
[CUSTOMER][NEUTRAL] It is if I give you another um ID number, can you try that as well please?
[AGENT][NEUTRAL] Yeah, of course.
[CUSTOMER][NEUTRAL] Let me know whenever you're ready.
[AGENT][POSITIVE] OK, I'm ready.
[CUSTOMER][NEUTRAL] 025668998
[AGENT][NEUTRAL] OK, yes, I see that one. OK, and that one is active.
[CUSTOMER][NEUTRAL] Yeah
[AGENT][NEUTRAL] OK. And then what kind of benefits were you looking for today? Outpatient?
[CUSTOMER][NEUTRAL] Uh, specialist office is it?
[AGENT][NEUTRAL] OK, just a moment, let me pull up his certificate.
[CUSTOMER][NEUTRAL] So
[AGENT][NEUTRAL] OK, so it looks like he has a physician office on his on his certificate.
[AGENT][NEUTRAL] Um,
[AGENT][NEUTRAL] Let's see.
[AGENT][NEUTRAL] OK, so this is not a guarantee of payment, it's just a verification of coverage. So it looks like the outpatient, outpatient physician office is $75 per day, maximum of 6 days per calendar year.
[CUSTOMER][NEUTRAL] OK, so it pays up to 75, is that correct?
[AGENT][NEUTRAL] Yes, $75 per day, max of 6 days. Mhm.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] And do we know um how many how many are currently left how many visits?
[AGENT][NEUTRAL] Uh, let me double check for you.
[AGENT][NEUTRAL] OK, so it looks like he has 5 left.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] And can you just confirm for me what um.
[CUSTOMER][NEUTRAL] What network does plan uses?
[AGENT][NEUTRAL] Let's see.
[AGENT][NEUTRAL] OK. There's not a certain network for this policy.
[CUSTOMER][NEUTRAL] So it doesn't have any assigned network?
[AGENT][NEUTRAL] No, sir. So we're just a secondary, um, company to their primary insurance.
[CUSTOMER][NEUTRAL] Are you showing a primary insurance listed?
[AGENT][NEUTRAL] I am not. You'd have to call the insured for that information.
[CUSTOMER][NEUTRAL] Got you. I just want to make sure they didn't put anything on file with you, OK, and [PII], is there any reference number for today's call or just your name?
[AGENT][NEUTRAL] Mm
[AGENT][NEUTRAL] Yes, it's just my first name, [PII] My last, my last name, the initial is [PII], and then it would be today's date.
[CUSTOMER][POSITIVE] Thank you I appreciate your help. You have a good day.
[AGENT][POSITIVE] Yeah, of course. Is there anything else I can help you with?
[CUSTOMER][POSITIVE] That's gonna be all. Have a good day.
[AGENT][POSITIVE] All right thank you you too. Thanks for calling APO right.