AccountId: 011433970860
ContactId: 5e28e257-35ae-40bc-a908-58f6f6becf44
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 191399 ms
Total Talk Time (AGENT): 81471 ms
Total Talk Time (CUSTOMER): 76563 ms
Interruptions: 2
Overall Sentiment: AGENT=1.4, CUSTOMER=0.6
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/04/08/5e28e257-35ae-40bc-a908-58f6f6becf44_20250408T18:46_UTC.wav
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[AGENT][NEUTRAL] Calling APL, this is [PII]. How may I assist you?
[CUSTOMER][NEUTRAL] Hi, good afternoon. I'm calling from a doctor's office. I need to verify benefits for a patient.
[AGENT][POSITIVE] Sure, I can assist you with that. Can I have your name and a callback number?
[CUSTOMER][NEUTRAL] [PII].
[CUSTOMER][NEUTRAL] [PII]
[AGENT][NEUTRAL] Thank you, and what is the member's policy number?
[CUSTOMER][NEUTRAL] Is the 3rd number, is that it?
[AGENT][NEUTRAL] Yes.
[CUSTOMER][NEUTRAL] 101.
[CUSTOMER][NEUTRAL] 1535.
[AGENT][NEUTRAL] Can you verify the patient's name and date of birth?
[CUSTOMER][NEUTRAL] [PII].
[CUSTOMER][NEUTRAL] Date of birth is uh.
[CUSTOMER][NEUTRAL] [PII].
[AGENT][POSITIVE] Thank you.
[AGENT][NEUTRAL] You're calling to verify benefits eligibility?
[CUSTOMER][POSITIVE] Thank you.
[CUSTOMER][NEUTRAL] Yes, for specialist offices.
[AGENT][NEUTRAL] And what was your name?
[CUSTOMER][NEUTRAL] [PII]
[AGENT][POSITIVE] Thank you, [PII].
[AGENT][NEUTRAL] [PII], this policy has been active since [PII] and it's currently active.
[AGENT][NEUTRAL] The member has
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] The member's policy does not cover office visits, however, the member does have outpatient benefits of $1500 per calendar year and the treatment received in the office cover is covered under the outpatient benefits, and this is not a guaranteed benefits, just a disclaimer of the policy's coverage.
[CUSTOMER][NEUTRAL] So you said is office visits are not covered.
[AGENT][POSITIVE] Correct, that's correct.
[CUSTOMER][NEUTRAL] OK, and it's only for outpatient surgery or for what?
[AGENT][NEUTRAL] Outpatient services as in treatment received in the office falls under the outpatient benefits.
[AGENT][NEUTRAL] Just the office visit itself is not covered.
[CUSTOMER][NEUTRAL] So
[CUSTOMER][NEUTRAL] So diagnostic testing or surgery in office, right?
[AGENT][NEUTRAL] Anything that's done in the office, any type of treatment received in the office would be covered, however, just the visit is not covered.
[CUSTOMER][NEUTRAL] OK, so now for the office visit, but yes, for diagnostic testing and surgery.
[CUSTOMER][NEUTRAL] Right
[AGENT][NEUTRAL] Any type of treatment, any type of treatment received in the office.
[CUSTOMER][NEUTRAL] Is covered up to a maximum of 1500.
[AGENT][NEUTRAL] Yes, that is correct. 1500 per calendar year, yes.
[CUSTOMER][POSITIVE] OK, thank you very much. I have a
[AGENT][NEUTRAL] Is there anything else that I can assist you with today?
[CUSTOMER][NEUTRAL] Yes, the reference number please.
[AGENT][NEUTRAL] We don't provide those [PII], but you can use my name in today's date as a reference.
[AGENT][NEUTRAL] My name is [PII], today's date.
[CUSTOMER][NEUTRAL] And your name is?
[CUSTOMER][NEUTRAL] [PII]
[AGENT][POSITIVE] Yes, that is correct.
[CUSTOMER][POSITIVE] Thank you have a good day bye bye.
[AGENT][POSITIVE] Thanks for calling APL. You have a great one as well. Goodbye.
[CUSTOMER][NEUTRAL] You too bye bye.
[AGENT][NEUTRAL] Hey Siri.