AccountId: 011433970860
ContactId: 63ac3ffc-7efe-4c6f-8627-f91c89200981
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 275869 ms
Total Talk Time (AGENT): 131772 ms
Total Talk Time (CUSTOMER): 91915 ms
Interruptions: 2
Overall Sentiment: AGENT=0.3, CUSTOMER=0.8
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/05/19/63ac3ffc-7efe-4c6f-8627-f91c89200981_20250519T15:24_UTC.wav
--------------------------------------------
[AGENT][NEUTRAL] Thank you for calling APL. This is [PII]. How may I help you?
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Hi, um, I'm calling from a pain management office. We have a new patient that has this as their secondary insurance plan. I just wanna check if we are in network or if this plan covers his primary insurance.
[AGENT][NEUTRAL] OK. All right. I can help you with the benefits for the patient. May I please get your name and your callback number?
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] [PII] is the first name. Our callback number is [PII].
[AGENT][NEUTRAL] OK and then [PII], what is the name of the office you're calling from?
[CUSTOMER][NEUTRAL] Doctor [PII]'s office.
[AGENT][NEUTRAL] OK, and then may I have the member's name, date of birth, and policy number?
[CUSTOMER][NEUTRAL] First name is [PII]. Last name is [PII]. Date of birth is [PII]. ID number is 01699850. M as in Mary, L as in Larry, number 8, and this is for his outpatient benefit certification number.
[AGENT][POSITIVE] OK, thank you very much. All right, so looking at this policy.
[AGENT][NEUTRAL] Um, for [PII], it did terminate on [PII].
[AGENT][NEUTRAL] Let me check though. He does have an active policy. Let me give you that policy number.
[AGENT][NEUTRAL] You just let me know when you're ready.
[CUSTOMER][NEUTRAL] Uh, give me one moment.
[AGENT][NEUTRAL] Yes, ma'am.
[CUSTOMER][NEUTRAL] OK, what is that number?
[AGENT][NEUTRAL] 247
[AGENT][NEUTRAL] 341 5.
[AGENT][NEUTRAL] And the effective date of the policy is [PII] and it's current.
[AGENT][NEUTRAL] And this is just to verify benefits. It's not a guarantee of payment.
[AGENT][NEUTRAL] Uh, he does have an outpatient per calendar day.
[AGENT][NEUTRAL] Benefit amount of $300 to go towards deductible, co-pay or co-insurance.
[CUSTOMER][NEUTRAL] Say that again.
[AGENT][NEUTRAL] He has a um outpatient benefit amount per calendar day of $300.
[CUSTOMER][NEUTRAL] I'm gonna call
[AGENT][NEUTRAL] To go towards deductible, co-pay, or co-insurance.
[CUSTOMER][NEUTRAL] just
[AGENT][NEUTRAL] For accident or sickness.
[CUSTOMER][NEUTRAL] Go talk with it.
[CUSTOMER][NEUTRAL] It goes towards deductible. What else?
[AGENT][NEUTRAL] Co-pay.
[CUSTOMER][NEUTRAL] I
[AGENT][NEUTRAL] Or co-insurance.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] For, um, accident or sickness.
[CUSTOMER][NEUTRAL] like
[CUSTOMER][NEUTRAL] OK, but we're pain management, so it wouldn't count towards us.
[CUSTOMER][POSITIVE] Correct.
[AGENT][NEUTRAL] Uh, let me see if he has office visits on his policy.
[AGENT][NEUTRAL] It'll be just a moment while I pull up his benefits.
[CUSTOMER][NEUTRAL] go.
[AGENT][NEUTRAL] For his policy certificate.
[AGENT][NEUTRAL] This policy does not cover uh physician's office visits.
[AGENT][NEUTRAL] So it would only cover treatment.
[AGENT][NEUTRAL] For co-insurance, deductible, or co-pay.
[AGENT][NEUTRAL] But not the office physician fee.
[CUSTOMER][NEUTRAL] OK, can I get a reference number please?
[AGENT][NEUTRAL] Yes, ma'am.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] You can use my name [PII], in today's date.
[CUSTOMER][POSITIVE] OK perfect thank you so much.
[AGENT][POSITIVE] You're very welcome, Miss [PII]. I hope you have a wonderful week and thank you for calling APL.
[CUSTOMER][POSITIVE] Thank you.
[AGENT][NEUTRAL] Bye-bye, ma'am.