AccountId: 011433970860
ContactId: 5ca5fcc8-5063-4012-b845-2da85dc2ddaa
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 219330 ms
Total Talk Time (AGENT): 102031 ms
Total Talk Time (CUSTOMER): 63722 ms
Interruptions: 0
Overall Sentiment: AGENT=2, CUSTOMER=0.7
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/05/12/5ca5fcc8-5063-4012-b845-2da85dc2ddaa_20250512T20:12_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, my name is [PII] calling from provider's office to obtain eligibility for the member.
[AGENT][POSITIVE] OK, well, I'll be more than happy to help you with the eligibility, [PII] And may I have a good contact number in case we're disconnected and the policy number?
[CUSTOMER][NEUTRAL] Sure. The callback number would be [PII].
[CUSTOMER][NEUTRAL] And the policy number would be 01568619.
[AGENT][POSITIVE] Thank you. Hold on one moment.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] And can you verify the member's first and last name and date of birth?
[CUSTOMER][NEUTRAL] Uh, the member's name would be [PII].
[CUSTOMER][NEUTRAL] And the date of birth would be on [PII].
[AGENT][NEUTRAL] Thank you for that and all the information provided is a verification of benefits, not a guarantee of payment. Um, so this particular policy is no longer active. It was effective from [PII], but there is an active policy, um, that is 251-1356.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] And it became effective on [PII].
[CUSTOMER][NEUTRAL] Uh, just now you have sent the policy ID?
[AGENT][NEUTRAL] I'm sorry?
[CUSTOMER][NEUTRAL] Uh, you said your uh number, it's 251-135-6?
[AGENT][NEUTRAL] Yes, that's the active policy number.
[CUSTOMER][NEUTRAL] OK, one moment. Let me note down it.
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK. Can I get the benefits for the member outpatient medical services?
[AGENT][NEUTRAL] Hold on one moment, let me go to that policy.
[CUSTOMER][NEUTRAL] No
[CUSTOMER][NEUTRAL] Mhm
[AGENT][NEUTRAL] All the information provided is a verification of benefits, not a guarantee of payment. So you said for outpatient benefits?
[CUSTOMER][NEUTRAL] Yes.
[AGENT][NEUTRAL] The policy would pay up to, hold on one moment.
[AGENT][NEUTRAL] It is combined.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] $2500 per person per calendar year.
[CUSTOMER][NEUTRAL] OK. Uh, it is, uh, out of the pocket or deductible limit?
[AGENT][NEUTRAL] I'm sorry?
[CUSTOMER][NEUTRAL] Uh, is it out of the pocket amount or deductible amount for the member?
[AGENT][NEUTRAL] Neither one. This is their secondary insurance, so that max $2500 is the max that we would pay towards outpatient expenses. We applied to the co-pay, deductible and co-insurance of coverage charges after primary.
[CUSTOMER][NEUTRAL] OK, thank you. Uh, does the member require authorization for colonoscopy?
[AGENT][NEUTRAL] No, prior authorization is not required.
[CUSTOMER][NEUTRAL] OK, thank you. Can I get the call reference number, please?
[AGENT][POSITIVE] You're welcome.
[AGENT][NEUTRAL] Sure, so there's no call reference number, but you can use my name and today's date, and again that's [PII], first initial and my last name is [PII], and then today's date.
[CUSTOMER][POSITIVE] OK, thank you, [PII]. Thank you for your assistance. Have a wonderful day.
[AGENT][POSITIVE] You also, and thanks for calling APL. Was there anything else I can assist you with today?
[CUSTOMER][POSITIVE] Uh, nothing right now. Thank you. Thank you for your assistance. Have a good day. Bye for now.
[AGENT][POSITIVE] Alright, thanks for calling APL. You're welcome. Bye-bye.