AccountId: 011433970860
ContactId: 6349478b-3723-475d-abb6-5ef56a275f20
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 263570 ms
Total Talk Time (AGENT): 96044 ms
Total Talk Time (CUSTOMER): 68759 ms
Interruptions: 0
Overall Sentiment: AGENT=1.2, CUSTOMER=1.4
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/04/25/6349478b-3723-475d-abb6-5ef56a275f20_20250425T16:23_UTC.wav
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[AGENT][POSITIVE] Thanks for calling APL. This is [PII]. How can I help you?
[CUSTOMER][NEUTRAL] Hi, I was just wondering if I could check benefits for a patient.
[AGENT][POSITIVE] OK, yes, I can help you with benefits. Can I get your name and a good callback number?
[CUSTOMER][NEUTRAL] Yes, [PII] um and then it's [PII].
[AGENT][NEUTRAL] OK, thank you, [PII]. Do you have the policy number of the patient?
[CUSTOMER][NEUTRAL] I do, uh, 02566595.
[AGENT][NEUTRAL] And patient name and date of birth?
[CUSTOMER][NEUTRAL] OK, I have [PII] [PII].
[AGENT][NEUTRAL] Uh, it looks like our policy is effective [PII]. It's currently active. And do you need benefits for outpatient hospital or?
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] It would be for like a specialist, uh, allergist, er allergy services.
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Those are covered. I have CPT codes. I'm not sure if you do it that way or just general.
[AGENT][NEUTRAL] Uh, yeah, I can just give you general, um, so is it in like, is it in a facility setting or a doctor's office or a clinic?
[CUSTOMER][NEUTRAL] That's fine.
[CUSTOMER][NEUTRAL] It'd be office, yeah, it'd be a doctor's office.
[AGENT][NEUTRAL] On a guarantee of payment basic outline of the policy.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] Um, let's see.
[AGENT][NEUTRAL] We have an outpatient benefit maximum of 3000 per covered person per calendar year. Let me see if doctors visits and
[AGENT][NEUTRAL] In an office setting or covered, sometimes it's not, so.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] Uh, it doesn't look like it would be a covered benefit. It just covers certain things like PT, OT, um, dialysis.
[AGENT][NEUTRAL] Uh
[CUSTOMER][NEUTRAL] OK, so it's not a covered service?
[AGENT][POSITIVE] Correct.
[CUSTOMER][NEUTRAL] Alright, that makes it easy. It's just a secondary anyway so um so no benefits for not covered services, mhm.
[AGENT][NEUTRAL] Actually, let me
[AGENT][POSITIVE] Yeah, let me, actually, let me look a little bit this other information. Sorry about that.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] I don't wanna tell you the wrong thing.
[CUSTOMER][POSITIVE] No worries.
[CUSTOMER][POSITIVE] Uh, works for me.
[AGENT][NEUTRAL] OK, it does specify other treatment in a physician's office, but it does not include the physician office fee.
[AGENT][NEUTRAL] So, it won't include the actual office visit, but treatment and procedures rendered inside the doctor's office would be covered.
[CUSTOMER][NEUTRAL] Covered at what uh.
[CUSTOMER][NEGATIVE] Sorry, I'm trying to wrap my head around this. It's Friday and my brain's dying, um.
[AGENT][NEUTRAL] Um, so it's, so we are a secondary policy, so after primary processing claim, if there's any deductible, co-pay or co-insurance left over, this policy will pay up to $3000 per calendar year.
[CUSTOMER][NEUTRAL] Right.
[CUSTOMER][NEUTRAL] Hm.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][POSITIVE] Perfect. And is there any accumulations towards that already?
[AGENT][NEUTRAL] Um, let me see if she's used anything so far.
[AGENT][NEUTRAL] Uh, it doesn't look like she's used anything this year.
[CUSTOMER][POSITIVE] Perfect. OK, uh, reference number and I'll get out of your hair.
[AGENT][NEUTRAL] Um, it's just my name, [PII], first initial to last name, [PII], and today's date.
[CUSTOMER][POSITIVE] Perfect thank you [PII] you have a wonderful weekend.
[AGENT][POSITIVE] Thank you, you as well. Thanks for calling APL.
[CUSTOMER][NEUTRAL] Alright bye bye.