AccountId: 011433970860
ContactId: 554bb08a-3525-4a51-9d1a-a17e615c5ea4
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 212100 ms
Total Talk Time (AGENT): 96923 ms
Total Talk Time (CUSTOMER): 58596 ms
Interruptions: 0
Overall Sentiment: AGENT=1.1, CUSTOMER=0.6
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/01/29/554bb08a-3525-4a51-9d1a-a17e615c5ea4_20250129T19:10_UTC.wav
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[AGENT][NEUTRAL] Thank you for calling APL. This is [PII]. How may I help you?
[CUSTOMER][NEUTRAL] Hi [PII], how are you? I'm calling from a provider's office. My name is [PII] and I'm calling to check on benefits on a patient that's here in the office.
[AGENT][NEUTRAL] OK, Ms. [PII], I can help you with benefits. Can you please give me your callback number?
[CUSTOMER][NEUTRAL] Yes, [PII]
[CUSTOMER][NEUTRAL] [PII]
[AGENT][NEUTRAL] Thank you. And what is the name of the facility you're calling from?
[CUSTOMER][NEUTRAL] Um, it's under Orta, Florida.
[AGENT][NEUTRAL] OK. And what is the patient's name?
[CUSTOMER][NEUTRAL] Uh, [PII], last name is [PII]
[AGENT][NEUTRAL] OK thank you and what's [PII]'s date of birth?
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] And his policy number, please?
[CUSTOMER][NEUTRAL] The policy number?
[AGENT][NEUTRAL] Yes ma'am.
[CUSTOMER][NEUTRAL] 01896036 M as in Mary, L as in Lima 8
[AGENT][POSITIVE] OK, thank you so much and let me pull in his policy real quick.
[AGENT][POSITIVE] So we can get you those benefits.
[AGENT][NEUTRAL] OK, I do show that [PII] does have an active policy. His effective date is [PII].
[AGENT][NEUTRAL] And this is just to verify coverage. It's not a guarantee of payment. He has a supplemental insurance policy that is a gap insurance that helps with deductible, co-pay, and co-insurance.
[AGENT][NEUTRAL] He has an inpatient benefit amount per calendar year of $2500 and then he also has an outpatient benefit amount per calendar year of $500.
[CUSTOMER][NEUTRAL] OK, um, so in order for us to do an injection here today in the office, would he be covered for that with you guys?
[AGENT][NEUTRAL] Let me look and see if he has office visits on his policy.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] He has office treatment.
[AGENT][NEUTRAL] But not the visits and his office treatment.
[AGENT][NEUTRAL] I
[AGENT][NEUTRAL] For outpatient. So the treatment, yes, but not the office visit.
[CUSTOMER][NEUTRAL] OK, so the injection will be covered because the injection will be based on deductible, um, so that will be covered.
[AGENT][NEUTRAL] Right, because the policy works based on deductible, co-pay, or co-insurance.
[CUSTOMER][NEUTRAL] 7
[CUSTOMER][NEUTRAL] OK, OK, so the, the office treatment is covered but not the office cover.
[AGENT][POSITIVE] Right, correct.
[CUSTOMER][NEUTRAL] OK, perfect. Can I get a reference number?
[AGENT][NEUTRAL] Yes, ma'am. You can use my name, [PII], and today's date.
[CUSTOMER][POSITIVE] OK [PII], perfect thank you so much for your help.
[AGENT][POSITIVE] You're welcome thank you you have a good day and thanks for calling APO.
[CUSTOMER][NEUTRAL] Hm.
[CUSTOMER][POSITIVE] No problem.
[AGENT][NEUTRAL] Bye bye