AccountId: 011433970860
ContactId: 5ef978f0-bbb5-417a-9777-26b0e7de8964
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 344519 ms
Total Talk Time (AGENT): 136327 ms
Total Talk Time (CUSTOMER): 139203 ms
Interruptions: 3
Overall Sentiment: AGENT=0.5, CUSTOMER=0.6
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/03/03/5ef978f0-bbb5-417a-9777-26b0e7de8964_20250303T20:38_UTC.wav
--------------------------------------------
[CUSTOMER][NEUTRAL] Yeah.
[AGENT][NEUTRAL] Thank you for calling APL. This is [PII]. How may I help you?
[CUSTOMER][NEUTRAL] Hi [PII], this is [PII]. I'm calling from [PII] ENT. I'm trying to get the eligibility for a mutual patient.
[AGENT][NEUTRAL] OK, I can help you with eligibility, [PII]. Can I please get your callback number just in case our call is disconnected?
[CUSTOMER][NEUTRAL] so
[CUSTOMER][NEUTRAL] Yes ma'am, [PII].
[CUSTOMER][NEUTRAL] Oh.
[AGENT][NEUTRAL] OK, thank you. And then what is the patient's name, date of birth, and policy number?
[CUSTOMER][NEUTRAL] OK
[CUSTOMER][NEUTRAL] The name is [PII] and the date of birth is [PII].
[AGENT][NEUTRAL] Thank you. And what's [PII]'s policy number?
[CUSTOMER][NEUTRAL] The policy number is.
[CUSTOMER][NEUTRAL] 0255694, I'm sorry 02556490 ML 7.
[AGENT][NEUTRAL] OK, let me pull up that policy real quick for.
[AGENT][NEUTRAL] For us
[AGENT][NEUTRAL] OK, I do show that [PII] does have an active policy and his effective date is [PII].
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] And can you please provide me um if office visits are covered, if office procedures are covered up to how much and how much has been used?
[AGENT][NEUTRAL] Yes, um, and this is just to verify his benefits. It's not a guarantee of payment. Let me look and see about office visits on the policy.
[CUSTOMER][NEUTRAL] That
[CUSTOMER][NEUTRAL] Yes
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] In.
[AGENT][NEUTRAL] Mm, let me pull up the policy. I'm gonna have to pull up the policy itself to see if it has office visits.
[CUSTOMER][NEUTRAL] No, I think we have
[CUSTOMER][POSITIVE] OK ma'am thank you.
[AGENT][POSITIVE] You're welcome.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][POSITIVE] Nice.
[CUSTOMER][NEUTRAL] [PII].
[CUSTOMER][NEUTRAL] Oh my [PII].
[CUSTOMER][NEUTRAL] Did I tell me.
[CUSTOMER][NEUTRAL] Sorry, [PII] [PII], it's from [PII].
[CUSTOMER][NEUTRAL] OK
[CUSTOMER][NEUTRAL] Bye.
[CUSTOMER][NEGATIVE] He sounds so cold on me.
[CUSTOMER][NEUTRAL] Yeah
[CUSTOMER][NEUTRAL] For [PII]
[CUSTOMER][NEUTRAL] Hi, can you
[CUSTOMER][NEUTRAL] OK
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] How can I find and I sign up.
[CUSTOMER][NEUTRAL] Yes.
[AGENT][NEUTRAL] OK, let's see.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] OK, so the office itself is not a physician office is not a covered outpatient facility.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] Um,
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK
[AGENT][NEUTRAL] So they do not have office visits, but let me give you the um outpatient benefits and this is just, you know, again to verify benefits, it's not a guarantee of payment. They can use an ER urgent care center, MRI imaging center or an ambulatory center and their outpatient benefits.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] Per calendar year is $8700.
[CUSTOMER][POSITIVE] Thank you.
[CUSTOMER][NEUTRAL] Up to 8000.
[AGENT][NEUTRAL] Um, let me
[AGENT][NEUTRAL] 8700 and this policy helps with deductible, co-pay or co-insurance. And I'm checking right now to see if anything's been used for [PII].
[CUSTOMER][NEUTRAL] So.
[CUSTOMER][NEUTRAL] It
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] [PII] himself.
[CUSTOMER][NEUTRAL] We would be considered outpatient or inpatient.
[AGENT][NEUTRAL] Inpatient is if they go into the hospital for 18 hours or more.
[CUSTOMER][NEUTRAL] OK, no, we're just a clinic.
[AGENT][NEUTRAL] OK. And then, right. And um,
[CUSTOMER][NEUTRAL] So outpatient then OK.
[AGENT][NEUTRAL] [PII] himself has not used any deductible this year at all.
[AGENT][NEUTRAL] Uh, any benefit, I'm sorry.
[CUSTOMER][POSITIVE] Alrighty perfect.
[AGENT][NEUTRAL] To go
[CUSTOMER][NEUTRAL] Perfect, [PII], can I please have a reference number for the call?
[AGENT][NEUTRAL] That
[CUSTOMER][POSITIVE] I'm sorry, [PII] bless.
[AGENT][POSITIVE] Yes ma'am, you can use my name [PII] in today's day. Thank you. I appreciate that. I tried to do it in a hurry so I could talk to you.
[CUSTOMER][POSITIVE] Sorry in today. You're welcome. I have allergies I have allergies also. I'm sorry. All right, sorry, you're great. Thank you. Thank you for your help.
[AGENT][NEUTRAL] Oh gosh, she's like.
[AGENT][POSITIVE] Thank you. You have a blessed day and thanks for calling APL [PII].
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][POSITIVE] Thank you ma'am you too bye bye.
[AGENT][NEUTRAL] Bye-bye.