AccountId: 011433970860
ContactId: 56f0f8f3-87e3-4524-bc64-757d046bacb5
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 249160 ms
Total Talk Time (AGENT): 119517 ms
Total Talk Time (CUSTOMER): 91761 ms
Interruptions: 2
Overall Sentiment: AGENT=1, CUSTOMER=0.9
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2024/12/30/56f0f8f3-87e3-4524-bc64-757d046bacb5_20241230T20:46_UTC.wav
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[CUSTOMER][NEUTRAL] Hello.
[AGENT][POSITIVE] Good afternoon. Thank you for calling APL. My name is [PII]. How may I help you?
[CUSTOMER][NEUTRAL] Hi, [PII]. I'm trying to get some benefits information.
[AGENT][POSITIVE] OK, I can definitely help you with the benefits. May I have your name and a good contact number in case we're disconnected?
[CUSTOMER][NEUTRAL] Mhm
[CUSTOMER][NEUTRAL] [PII], and it's [PII].
[AGENT][NEUTRAL] Thank you for that. And [PII], may I have the member's policy number?
[CUSTOMER][NEUTRAL] 01783671
[AGENT][NEUTRAL] Thank you, hold on one moment.
[CUSTOMER][POSITIVE] Thank you
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] And can you verify the member's first and last name and date of birth?
[CUSTOMER][NEUTRAL] My first and last name
[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 um I am showing the policy is active, it's been effective since [PII]. And what type of benefits did you want to go over?
[CUSTOMER][NEUTRAL] The
[CUSTOMER][NEUTRAL] Verification benefits.
[CUSTOMER][NEUTRAL] [PII].
[CUSTOMER][NEUTRAL] Specialist office copay along with outpatient surgery benefits for the physician, general deductible and out of pocket and screening colonoscopy.
[AGENT][NEUTRAL] OK, hold on one moment.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] So I'm just waiting for the benefits to come up here.
[CUSTOMER][NEUTRAL] I'm just looking for the benefits.
[CUSTOMER][POSITIVE] OK, thank you.
[AGENT][NEUTRAL] You're welcome. Um, so for outpatient, the policy will pay up to $4000 per calendar year per person.
[CUSTOMER][POSITIVE] You're welcome. I'm so.
[CUSTOMER][NEUTRAL] Yeah
[AGENT][NEUTRAL] That does include diagnostic testing in an outpatient um hospital facility or MRI facility.
[CUSTOMER][NEUTRAL] That does include diagnostic.
[CUSTOMER][NEUTRAL] Hospital
[AGENT][NEUTRAL] There is also a $25 per visit with a max of 4 visits per calendar year for the office setting.
[CUSTOMER][NEUTRAL] There is.
[CUSTOMER][NEUTRAL] year
[AGENT][NEUTRAL] This policy is their secondary policy, so we don't apply a co-pay, but if their primary does, we assist with paying the co-pay, deductible or co-insurance after primary.
[CUSTOMER][NEUTRAL] This is.
[CUSTOMER][NEUTRAL] Insurance after
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Have they used all 4 of their visits?
[AGENT][NEUTRAL] And
[AGENT][NEUTRAL] Let's see, hold on one second.
[AGENT][NEUTRAL] Yes, they've used all for the visits and for the diagnostic test and let me see if they've used all the outpatient. Hold on one second. What's the max?
[CUSTOMER][NEUTRAL] Yes, they've used um.
[CUSTOMER][NEUTRAL] And for the
[CUSTOMER][NEUTRAL] I
[AGENT][NEUTRAL] 4000.
[AGENT][NEUTRAL] OK, so she's used $2,941.26.
[CUSTOMER][NEUTRAL] OK, so.
[CUSTOMER][NEUTRAL] 24.
[AGENT][NEUTRAL] Um, so she has $1,058.74 left for the year.
[CUSTOMER][NEUTRAL] Um, so she has 1000.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] There was a $250 deductible for outpatient, but she's met that also.
[CUSTOMER][NEGATIVE] There was a too much.
[CUSTOMER][NEUTRAL] OK, any pre-certs needed for like a colonoscopy or EGD?
[AGENT][NEUTRAL] No, ma'am, no preset or prior all.
[CUSTOMER][NEUTRAL] And you said there's no coinsurance, correct?
[AGENT][NEUTRAL] Right, we don't apply the co-pay, we help pay it.
[CUSTOMER][NEUTRAL] Right, we don't apply.
[CUSTOMER][NEUTRAL] Um, claims address.
[AGENT][NEUTRAL] It's [PII].
[CUSTOMER][NEUTRAL] Is [PII].
[AGENT][NEUTRAL] [PII].
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] [PII].
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] [PII]
[AGENT][NEUTRAL] The zip code is [PII].
[CUSTOMER][NEUTRAL] The zip code is [PII].
[CUSTOMER][POSITIVE] OK, that's all I needed. Thank you so much.
[AGENT][POSITIVE] You're very welcome. Well, thanks for calling APL and I hope you have a great day and a happy [PII], [PII].
[CUSTOMER][POSITIVE] You're very welcome well thanks.
[CUSTOMER][POSITIVE] You as well thank you bye bye.
[AGENT][POSITIVE] Thank you. Bye bye.