AccountId: 011433970860
ContactId: 6c53be4c-e937-4c13-919d-5893d6546d1d
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 195320 ms
Total Talk Time (AGENT): 84046 ms
Total Talk Time (CUSTOMER): 62270 ms
Interruptions: 0
Overall Sentiment: AGENT=0.3, CUSTOMER=1.4
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/01/15/6c53be4c-e937-4c13-919d-5893d6546d1d_20250115T14:22_UTC.wav
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[AGENT][NEUTRAL] Thank you for calling APL. This is [PII]. How can I help you?
[CUSTOMER][NEUTRAL] Hi [PII], good morning. This is [PII] from Cleveland Clinic. Could you hear me verify any information that I have here is active, please?
[AGENT][NEUTRAL] Yes, and may I have your name again?
[CUSTOMER][NEUTRAL] My name is [PII].
[AGENT][NEUTRAL] What is your callback number if disconnected please [PII]?
[CUSTOMER][NEUTRAL] Yes, [PII].
[AGENT][NEUTRAL] OK, and just to make sure I have your name spelled correctly, spell your first name for me?
[CUSTOMER][NEUTRAL] [PII]
[AGENT][NEUTRAL] Thank you. What is the policy number please?
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Yes, that is going to be 02464982.
[AGENT][NEUTRAL] Thank you, verify the patient's name and date of birth.
[CUSTOMER][NEUTRAL] Oh, [PII] [PII].
[AGENT][NEUTRAL] OK, thank you [PII] and you're calling to check for eligibility and benefits, is that correct for both?
[CUSTOMER][NEUTRAL] Let me see this for um let me see this is for.
[CUSTOMER][NEUTRAL] Eligibility, network status and refill requirements.
[AGENT][NEUTRAL] OK, the patient shows effective as of [PII]. This is a supplemental medical policy to her major medical. We do not have a network of providers.
[CUSTOMER][NEUTRAL] So you guys are like basically open access right?
[AGENT][NEUTRAL] Correct, we're supplemental to her major medical, there's no network.
[CUSTOMER][POSITIVE] Thank you.
[AGENT][NEUTRAL] Certainly.
[CUSTOMER][NEUTRAL] So plan
[CUSTOMER][NEUTRAL] Do you guys need a referral to see a specialist?
[AGENT][NEUTRAL] No, no referrals are needed.
[AGENT][NEUTRAL] No pre resource of preauthorizations. You're welcome.
[CUSTOMER][POSITIVE] Thank you, can you hear me?
[CUSTOMER][POSITIVE] Thank you, can you hear me with the benefits?
[AGENT][NEUTRAL] Of course one moment.
[CUSTOMER][NEUTRAL] For
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] OK, please note verification of benefits provided does not guarantee payment. Now you mentioned an office visit or specialist office visit and she does not have a benefit to cover office visit fee. She does have a benefit to help cover that could help cover services or procedures inside the office but not for the office visit fee.
[CUSTOMER][NEGATIVE] Got it, so no benefits.
[AGENT][NEUTRAL] And the outpatient max for the year is $2500. That's for all covered outpatient services.
[CUSTOMER][NEUTRAL] Oh.
[CUSTOMER][POSITIVE] Thank you, let me see, what was your name again? I'm sorry.
[AGENT][NEUTRAL] My name is [PII], that's [PII] Last initial is [PII].
[CUSTOMER][NEUTRAL] Thank you and do you have a call reference number by any chance?
[AGENT][NEUTRAL] No, but you can use my name in today's date. Anything else I can help you with please, [PII]?
[CUSTOMER][POSITIVE] Not at the moment, thank you very much for asking.
[AGENT][NEUTRAL] OK.
[AGENT][POSITIVE] You're welcome, sir. Thank you so much for calling APL. Have a great day.
[CUSTOMER][POSITIVE] Have a good day as well bye bye.
[AGENT][NEUTRAL] Bye.