AccountId: 011433970860
ContactId: 5689079e-77c6-4408-93ca-40f6dd803c72
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 143500 ms
Total Talk Time (AGENT): 89919 ms
Total Talk Time (CUSTOMER): 50048 ms
Interruptions: 2
Overall Sentiment: AGENT=1.2, CUSTOMER=1.3
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/02/05/5689079e-77c6-4408-93ca-40f6dd803c72_20250205T18:30_UTC.wav
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[AGENT][NEUTRAL] Thank you for calling APL. This is [PII]. How can I help you?
[CUSTOMER][NEUTRAL] Hi [PII]. My name is [PII]. I'm trying to get eligibility and benefits on one of our patients.
[AGENT][NEUTRAL] OK, I can check eligibility and benefits for you. uh, [PII], can I get a good call back number from you first in case we're disconnected?
[CUSTOMER][NEUTRAL] Yep it's [PII].
[AGENT][NEUTRAL] Alright, thank you. And then do you have the policy number?
[CUSTOMER][NEUTRAL] It is 01897877.
[AGENT][NEUTRAL] OK, thank you. And what was the name and date of birth for the insured?
[CUSTOMER][NEUTRAL] [PII] and [PII].
[AGENT][NEUTRAL] Perfect, thank you for verifying that, [PII]. Uh, 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. And we need to look at the outpatient benefits.
[CUSTOMER][NEUTRAL] Uh, yes, for specialist office.
[AGENT][NEUTRAL] Office that that's OK. Let me see if that's gonna be covered. And of course, I'll let you know uh verification of coverage is not a guarantee of payment for claims. Uh, so under this policy, office visits are not going to be covered. Uh, however, treatment received in office could be.
[AGENT][NEUTRAL] That would fall under their outpatient benefit. Mhm.
[CUSTOMER][NEUTRAL] OK, so if she would have, uh, yeah, OK, and so say she had a biopsy or something taken with a dermatologist, that what would they cover on that?
[AGENT][NEUTRAL] Right, right, it's the office visit is going to be more for if it was just simply like a consultation or something, um, so the outpatient benefit is $3500 max per calendar year and I know we're still at the beginning, but I will go ahead and double check to see if any of that has been used.
[CUSTOMER][POSITIVE] Correct.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] OK, no, none has been used so far this year.
[CUSTOMER][NEUTRAL] OK, alright, that's all I needed then if I could just get a reference number.
[AGENT][NEUTRAL] Sure, it would just be my first name, last initial, and today's date. Uh, so my name is spelled [PII] Uh, was there anything else I could help you with?
[CUSTOMER][NEUTRAL] Uh-huh.
[CUSTOMER][POSITIVE] No, that was everything. Thank, thank you so much.
[AGENT][POSITIVE] OK, yeah, thanks for calling APL. I hope you have a great rest of your day.
[CUSTOMER][POSITIVE] You too thank you.
[AGENT][POSITIVE] Thank you, bye bye.
[CUSTOMER][NEUTRAL] Mm bye bye.