AccountId: 011433970860
ContactId: 6b04110c-e3fe-4b30-af04-67f4360b73d1
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 550580 ms
Total Talk Time (AGENT): 108164 ms
Total Talk Time (CUSTOMER): 110706 ms
Interruptions: 1
Overall Sentiment: AGENT=0.8, CUSTOMER=1.9
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/04/09/6b04110c-e3fe-4b30-af04-67f4360b73d1_20250409T19:12_UTC.wav
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[AGENT][NEUTRAL] Thank you for calling APL. This is [PII]. How may I help you?
[CUSTOMER][NEUTRAL] Hi, good afternoon, [PII]. My name is [PII], last name initial [PII], and I'm calling to verify a patient's benefits with you.
[AGENT][POSITIVE] Yes, of course, [PII]. I can help you with benefits today.
[CUSTOMER][POSITIVE] Thank you so much, [PII].
[AGENT][NEUTRAL] Of course. Do you have the policy number?
[CUSTOMER][NEUTRAL] Uh, yes, it would be, let me pull that up really quick. Um, 02255658, M as in Mike, L as in Lima, 8.
[AGENT][POSITIVE] OK, thank you.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] And then what's a good call back number in case our call gets dropped?
[CUSTOMER][NEUTRAL] It would be [PII].
[AGENT][NEUTRAL] OK, perfect. And then what's the patient's first and last name and date of birth?
[CUSTOMER][NEUTRAL] Mhm it would be uh [PII].
[CUSTOMER][NEUTRAL] And date of birth is [PII].
[AGENT][POSITIVE] OK, perfect.
[AGENT][NEUTRAL] OK. And are you looking for outpatient benefits or inpatient?
[CUSTOMER][NEUTRAL] Um, it would be for ambulatory surgical center, non-hospital based outpatient.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] See
[AGENT][NEUTRAL] Just 1 2nd.
[CUSTOMER][POSITIVE] Mhm, no worries, take your time.
[AGENT][NEUTRAL] OK, so it looks like they have an outpatient benefit. This is max per calendar year.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] And this amount is $1000.
[CUSTOMER][POSITIVE] Perfect. So $1000 is the deductible max.
[AGENT][NEUTRAL] Yes, and
[AGENT][NEUTRAL] It's not, so this is just for the outpatient benefit. Let's see if it is, just one second, I'll look to see if.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][POSITIVE] It applies to the deductible.
[CUSTOMER][POSITIVE] No worries.
[CUSTOMER][NEUTRAL] You said the address
[CUSTOMER][NEUTRAL] I
[AGENT][NEUTRAL] OK, so the office visit is not covered for co-pays.
[CUSTOMER][NEUTRAL] Sorry, can you repeat that again? You got cut out.
[AGENT][NEUTRAL] Uh, yeah, so the office visit is not covered.
[CUSTOMER][POSITIVE] Perfect. So, um, for ambulatory surgical center non hospital based outpatient, he wouldn't be covered?
[AGENT][NEUTRAL] Uh, let me put you on a brief hold and ask, um, one of my colleagues about that, OK?
[CUSTOMER][POSITIVE] Mhm thank you.
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEGATIVE] You are on hold.
[AGENT][NEUTRAL] Oh no, it's
[AGENT][NEUTRAL] That.
[AGENT][NEUTRAL] Um.
[CUSTOMER][NEGATIVE] You are on hold.
[AGENT][POSITIVE] Hey, [PII], thank you for holding.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] So, ambulatory Surgery Center is covered under the outpatient benefit that I quoted you, the $1000 per calendar year.
[CUSTOMER][POSITIVE] Perfect.
[AGENT][NEUTRAL] It's just the copay, um.
[CUSTOMER][POSITIVE] Perfect, so it would be, OK, perfect, perfect, so a $1000 maximum.
[AGENT][NEUTRAL] Yes, per calendar year and this is not a guaranteed payment, it's just a verification of coverage.
[CUSTOMER][NEUTRAL] Perfect per calendar year and um can you please tell me what the net amount is in the remaining balance?
[AGENT][NEUTRAL] OK. Mhm.
[AGENT][NEUTRAL] Let's see here.
[AGENT][NEUTRAL] OK, so it looks like the patient has not used any benefits as of this year.
[CUSTOMER][POSITIVE] Perfect, so the remaining balance would just be the 1000.
[AGENT][NEUTRAL] Yes, ma'am.
[CUSTOMER][POSITIVE] Perfect, thank you so so much, [PII] and [PII], if you don't mind me asking, can I please get your last name, letter initial as well as a reference number for today's call?
[AGENT][NEUTRAL] Yes, so the reference number would be my first name.
[AGENT][NEUTRAL] Which is [PII]
[AGENT][NEUTRAL] And then last initial [PII]
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][POSITIVE] Perfect.
[AGENT][NEUTRAL] And it would be today's date.
[CUSTOMER][NEUTRAL] Perfect for [PII] and would I have to add the time or would the date work?
[AGENT][NEUTRAL] No, just the date.
[CUSTOMER][POSITIVE] Perfect thank you so so much I really appreciate all your help today, [PII], and I hope you have a wonderful day and rest of the week.
[AGENT][NEUTRAL] Mhm.
[AGENT][NEUTRAL] Yeah
[AGENT][POSITIVE] Thank you for calling APO. Have a good day.
[CUSTOMER][POSITIVE] Thank you too bye bye.
[AGENT][NEUTRAL] OK. Yeah. Bye.