AccountId: 011433970860
ContactId: 615a2b33-2133-4d03-a9d2-6a48878112df
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 229000 ms
Total Talk Time (AGENT): 107470 ms
Total Talk Time (CUSTOMER): 73072 ms
Interruptions: 0
Overall Sentiment: AGENT=2, CUSTOMER=0.3
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/06/20/615a2b33-2133-4d03-a9d2-6a48878112df_20250620T20:55_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, [PII]. My name is [PII]. I'm calling from a specialist office at UT Southwestern and I'm trying to determine um if patients coverage will cover um as secondary for a specialist office visit. Um, I'm not sure if I chose the correct option.
[AGENT][POSITIVE] You did. I'll be more than happy to help you um with the eligibility and benefits. And [PII], may I have a good contact number in case we're disconnected?
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Yes, uh [PII], option number 3.
[AGENT][NEUTRAL] Thank you. And may I have the member's policy number?
[CUSTOMER][NEUTRAL] Yes, um, I have 02449815.
[AGENT][NEUTRAL] Thank you, hold on one moment.
[AGENT][NEUTRAL] And can you verify the member's first and last name and date of birth?
[CUSTOMER][NEUTRAL] Yes, uh, [PII], um,
[CUSTOMER][NEUTRAL] Let's see.
[CUSTOMER][NEUTRAL] Last name [PII]. I'm probably mispronounced but it's [PII] Date of birth [PII].
[AGENT][NEUTRAL] Thank you for that and all the information provided is a verification of benefits, not a guarantee of payment. So I am showing that the policy is active. It's been effective since [PII].
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] And for a specialist office visit, hold on one moment.
[AGENT][NEUTRAL] So that would be under outpatient, um, our outpatient, the policy will pay up to $200 per calendar year for outpatient expenses. Now, depending on how you bill, there is no coverage on the policy for the facility like place of service 99213, 99214, but she does have the office treatment rider, so the treatment in the office could be covered as long as it's not cosmetic.
[AGENT][NEUTRAL] Up to that $200 per calendar. Hold on one second, let me make sure I'm reading that right. Is that the deductible I'm looking at? I'm sorry, the outpatient calendar year max is $2000 per calendar year, my apologies. I'm glad I noticed that.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Is how much again?
[AGENT][NEUTRAL] It's 2000 per calendar year.
[CUSTOMER][NEUTRAL] Per calendar year. OK.
[AGENT][NEUTRAL] And did you want me to see if it's been used?
[CUSTOMER][NEUTRAL] Uh yes, please.
[AGENT][NEUTRAL] OK, hold on one moment.
[AGENT][NEUTRAL] OK, she has used the full 2000 for the year though.
[CUSTOMER][NEUTRAL] So, OK, so up to, well, out of pocket max 2000 already used the 2000.
[AGENT][NEUTRAL] Right, she's already used the 2000 for [PII].
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] I will document this um that's actually what I needed um is there a call reference I can use?
[AGENT][NEUTRAL] Um, so there's no call reference number, but you can use my name in today's date. The first initial of my last name is [PII].
[CUSTOMER][POSITIVE] OK. Thank you for your help today.
[AGENT][POSITIVE] You're very welcome and thanks for calling APL. Was there anything else I can help you with?
[CUSTOMER][NEUTRAL] That was everything.
[AGENT][POSITIVE] Alright, have a great weekend.
[CUSTOMER][NEUTRAL] You too bye bye.
[AGENT][POSITIVE] Thank you