AccountId: 011433970860
ContactId: 6e4c099d-1aeb-4f42-8f56-a547d6e6d7c4
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 194740 ms
Total Talk Time (AGENT): 88209 ms
Total Talk Time (CUSTOMER): 70597 ms
Interruptions: 0
Overall Sentiment: AGENT=1.1, CUSTOMER=0.8
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/01/09/6e4c099d-1aeb-4f42-8f56-a547d6e6d7c4_20250109T19:16_UTC.wav
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[AGENT][NEUTRAL] Thank you for calling APL. This is [PII]. How can I help you?
[CUSTOMER][NEUTRAL] Hi, my name is [PII]. I'm calling from Advanced Orthopedics. I'm calling to check the eligibility and benefits for a patient.
[AGENT][NEUTRAL] OK, yeah, I can check eligibility and benefits for you. I'm sorry, what did you say your name was?
[CUSTOMER][NEUTRAL] [PII]
[AGENT][NEUTRAL] Could you spell that for me?
[CUSTOMER][NEUTRAL] [PII] Yes, ma'am.
[AGENT][POSITIVE] OK, I appreciate it and then can I get a good call back number from you in case we're disconnected please?
[CUSTOMER][NEUTRAL] Yes, it's [PII].
[AGENT][NEUTRAL] OK thank you uh do you have the policy number?
[CUSTOMER][NEUTRAL] I do. Policy number is 01702711.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] Thank you and what was the name and date of birth for the insured?
[CUSTOMER][NEUTRAL] [PII] date of birth is [PII].
[AGENT][NEUTRAL] OK, thank you for verifying that fine. So the policy is active. Effective date was [PII], and this is a secondary medical policy that is designed to help with co-pay, deductible and co-insurance after major medical pays.
[AGENT][NEUTRAL] So we're needing to look at uh outpatient benefits, right?
[CUSTOMER][NEUTRAL] Yes, please.
[AGENT][NEUTRAL] OK, of course I will let you know verification of coverage is not a guarantee of payment for claims. The outpatient benefit is $4000 max per calendar year. I know the year just started, but I will still double check to see if any of that has been used.
[CUSTOMER][NEUTRAL] After
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] OK, none of it has.
[CUSTOMER][NEUTRAL] OK, you said how much for 100 or 4000 because you, you cut out a little bit.
[AGENT][NEUTRAL] 4000, sorry, 4000 per calendar year, yes.
[CUSTOMER][NEUTRAL] 1000 got it.
[CUSTOMER][POSITIVE] Awesome thank you got plans.
[CUSTOMER][NEUTRAL] And that goes towards deductible and coinsurance you said co-pay deductible and coinsurance or just?
[AGENT][NEUTRAL] Correct, it can go towards uh co-pay, deductible and co-insurance.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][POSITIVE] Got it awesome, and they are currently active right perfect uh do we have, um, I'm so sorry, what's your name again?
[AGENT][NEUTRAL] That's OK. Did you need a reference number?
[CUSTOMER][NEUTRAL] Yes.
[AGENT][NEUTRAL] OK, so the reference number would just be my first name, last initial, and today's date. Uh, so my name is spelled [PII] And was there anything else I could help you with Fallon?
[CUSTOMER][NEUTRAL] No ma'am, that was all.
[AGENT][POSITIVE] Alright, well thanks for calling APL. I hope you have a great rest of your day.
[CUSTOMER][POSITIVE] Thank you you too.
[AGENT][POSITIVE] Thank you bye bye.
[CUSTOMER][NEUTRAL] OK.