AccountId: 011433970860
ContactId: 66eb8031-c142-4540-8d14-73fd4cd6394d
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 241929 ms
Total Talk Time (AGENT): 117578 ms
Total Talk Time (CUSTOMER): 56885 ms
Interruptions: 0
Overall Sentiment: AGENT=0, CUSTOMER=1.2
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/01/23/66eb8031-c142-4540-8d14-73fd4cd6394d_20250123T19:07_UTC.wav
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[AGENT][NEUTRAL] Calling APL, this is [PII]. How may I assist you today?
[CUSTOMER][NEUTRAL] Hi, my name is [PII]. I'm calling to verify eligibility and benefits, please.
[AGENT][NEUTRAL] All right, [PII], can I have a callback number please?
[CUSTOMER][NEUTRAL] [PII]
[AGENT][NEUTRAL] May I have your policy number?
[CUSTOMER][NEUTRAL] Yes, and that is 02465907.
[CUSTOMER][NEUTRAL] M as in mother, L as in Lima, the number 8.
[AGENT][NEUTRAL] Could you please verify the member's name and date of birth?
[CUSTOMER][NEUTRAL] [PII] [PII].
[AGENT][NEUTRAL] Alright, thank you so much for verifying the information. Today you're calling for eligibility and benefits. The member is currently active with us with the effective date of [PII].
[AGENT][NEUTRAL] This is a supplemental policy where we will cover co-payments, co-insurance and deductibles if the member major medical leaves patient responsibility. But is there anything else I can verify for you today?
[CUSTOMER][NEUTRAL] No,
[CUSTOMER][NEUTRAL] Yes, I'm trying to also verify benefits for the same patient, um, for outpatient services benefits.
[AGENT][NEUTRAL] Did you say outpatient surgery?
[CUSTOMER][NEUTRAL] Outpatient services.
[AGENT][NEUTRAL] Oh, services, OK, one moment please.
[CUSTOMER][POSITIVE] No, no surgery. Yes. Thank you.
[AGENT][NEUTRAL] What type of services are you trying to talk, what are, what are you referring to though?
[CUSTOMER][NEUTRAL] So the patient's coming in for an ultrasound of the transvaginal.
[AGENT][NEUTRAL] While I pull up the member's benefits, this is a verification of their coverage and not a guarantee for payment. The outpatient benefit is $3000 per calendar day for outpatient services. Those outpatient services does include um diagnostic testing in a hospital, outpatient facility, or MRI facility.
[CUSTOMER][NEUTRAL] Yeah.
[AGENT][NEUTRAL] Um, is this in the doctor's office?
[CUSTOMER][NEUTRAL] Mhm. Yes.
[AGENT][NEUTRAL] OK. I'm gonna have to get you over to the supplemental area. You have reached um
[AGENT][NEUTRAL] Cancer, um, so.
[AGENT][NEUTRAL] I'm not too sure, so I would have to get you to the correct department, OK?
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][POSITIVE] All right, no worries, thank you so much.
[CUSTOMER][NEUTRAL] Yeah
[CUSTOMER][NEUTRAL] I need a paper clip.
[CUSTOMER][NEUTRAL] Conferring.
[CUSTOMER][NEUTRAL] This is [PII]. How can I help you?
[AGENT][NEUTRAL] Hello?
[CUSTOMER][POSITIVE] Thank you for contacting ATL. My name is [PII]. How may I help you?
[AGENT][NEUTRAL] [PII], this is [PII] in the cancer cue. I have a provider on the phone. Her name is [PII]. Callback number [PII]. This is on policy 246-5907.
[AGENT][NEUTRAL] I have assisted [PII] with eligibility for this member. She's asking about benefits for an ultrasound, a trans um vaginal ultrasound in a office um setting. I'm not too sure about that. Can you assist her, please?
[CUSTOMER][POSITIVE] Yes, I would be glad to thank you.
[AGENT][NEUTRAL] One moment.