AccountId: 011433970860
ContactId: 6185198b-3fc6-4d98-a539-3242fc624425
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 342609 ms
Total Talk Time (AGENT): 150540 ms
Total Talk Time (CUSTOMER): 113203 ms
Interruptions: 1
Overall Sentiment: AGENT=0.6, CUSTOMER=0.4
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/06/06/6185198b-3fc6-4d98-a539-3242fc624425_20250606T16:06_UTC.wav
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[AGENT][NEUTRAL] Calling APL. This is [PII]. How may I assist you?
[CUSTOMER][NEUTRAL] I am calling for some benefits for patients.
[AGENT][POSITIVE] Sure, I can assist you with that. Can I have your name and a callback number?
[CUSTOMER][NEUTRAL] Yeah, so that number is [PII].
[AGENT][NEUTRAL] I do apologize.
[AGENT][NEUTRAL] I'm not, ma'am.
[AGENT][NEUTRAL] I don't mean to cut you off, but your phone is I mean you sound like a robot. Could you repeat your name and your callback number for me?
[CUSTOMER][NEUTRAL] My name is [PII]. Callback number is [PII].
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] Could you repeat your number again? I apologize.
[CUSTOMER][NEUTRAL] [PII]
[CUSTOMER][NEUTRAL] It's [PII]
[AGENT][NEUTRAL] And the callback number?
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] Thank you, [PII]. So I have [PII].
[CUSTOMER][NEUTRAL] Yes
[AGENT][POSITIVE] I have the policy number of the member that you're calling to verify eligibility for today and I'll be able to assist you.
[CUSTOMER][NEUTRAL] OK, the member ID is, let me check.
[CUSTOMER][NEUTRAL] 02570532
[AGENT][NEUTRAL] Could you verify that patient's name and date of birth for me, [PII]?
[CUSTOMER][NEUTRAL] [PII].
[CUSTOMER][NEUTRAL] Date of birth is [PII].
[AGENT][NEUTRAL] And you're calling to verify benefits eligibility for outpatient services?
[CUSTOMER][NEUTRAL] Yes.
[CUSTOMER][NEUTRAL] For specialist.
[AGENT][NEUTRAL] Of office visits. This policy has been active since [PII] and it's currently active. The policy does not cover office visits, however, the treatment received in the office files under the outpatient benefits.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] And the outpatient benefit is $3000.
[CUSTOMER][NEUTRAL] It's not covered?
[AGENT][NEUTRAL] Office visits are not covered under the policy.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Is there any co-payment?
[AGENT][NEUTRAL] Now, this policy is a gap insurance that assists with the deductible copay and co-insurance to the primary, and the member has outpatient benefits of.
[AGENT][NEUTRAL] Let me give you the outpatient benefit amount $3000 per calendar year, and this is not a guaranteed benefits, just a disclaimer of the policy coverage. The office visits are not covered. However, the treatment received in the office will fall under the outpatient benefits.
[CUSTOMER][NEUTRAL] OK, what is the effective date?
[AGENT][NEUTRAL] [PII] and is currently active.
[CUSTOMER][POSITIVE] OK thank you.
[AGENT][NEUTRAL] Is there anything else that I can assist you with today, [PII]?
[CUSTOMER][NEUTRAL] Yes, what is the type of plan?
[AGENT][NEUTRAL] This is a gap insurance that assists with the deductible, co-pay and co-insurance to the primary.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] What?
[CUSTOMER][NEUTRAL] E
[CUSTOMER][NEUTRAL] Let me check, it's an authorization needed for an office procedure?
[AGENT][NEUTRAL] Could you repeat yourself?
[CUSTOMER][NEUTRAL] Is an authorization needed for an office procedure?
[AGENT][NEUTRAL] No.
[CUSTOMER][NEUTRAL] And is a referral needed for office visit?
[AGENT][NEUTRAL] No.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][POSITIVE] Thank you so much for the information.
[AGENT][POSITIVE] You're welcome.
[CUSTOMER][NEUTRAL] Can I get the billing address? I'm sorry.
[AGENT][NEUTRAL] The billing address will be addressed to APL claims department, [PII]. That's [PII], [PII].
[AGENT][NEUTRAL] It's [PII].
[AGENT][NEUTRAL] That's [PII]. We have a payer ID as well. Would you like that payer ID, [PII]?
[CUSTOMER][NEUTRAL] OK, and can I get your name and reference code please?
[AGENT][NEUTRAL] Would you like the payer ID to send it electronically as well? We have that option as well. Would you like that ID number?
[CUSTOMER][NEUTRAL] No, it's not necessary.
[AGENT][NEUTRAL] We don't provide reference numbers. You can use my name and today's date as a reference. My name is [PII] and today's date.
[CUSTOMER][NEUTRAL] OK, could you spell it?
[AGENT][NEUTRAL] [PII] in today's date.
[CUSTOMER][POSITIVE] OK, thank you so much for this information.
[AGENT][POSITIVE] Thanks for calling APL. Have a great day, [PII]. Goodbye.
[CUSTOMER][NEUTRAL] You too bye.
[AGENT][NEUTRAL] 1 1616.