AccountId: 011433970860
ContactId: 704109c0-ecb7-4cf5-b86f-cadca843a995
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 249460 ms
Total Talk Time (AGENT): 125600 ms
Total Talk Time (CUSTOMER): 69500 ms
Interruptions: 0
Overall Sentiment: AGENT=1.2, CUSTOMER=0.8
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/02/11/704109c0-ecb7-4cf5-b86f-cadca843a995_20250211T16:18_UTC.wav
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[AGENT][POSITIVE] Good morning. Thank you for calling APL. My name is [PII]. How may I help you?
[CUSTOMER][POSITIVE] Hi [PII], yes, I'm calling because I need to get benefits for a patient.
[AGENT][POSITIVE] OK, well, I can definitely help you with the benefits. May I have your name and a good contact number in case we're disconnected?
[CUSTOMER][NEUTRAL] Yes, my name is [PII] [PII].
[AGENT][NEUTRAL] Thank you for that. And [PII], may I have the member's policy number?
[CUSTOMER][NEUTRAL] Yes, ma'am. The policy is 01822528 M as in Mary, L as in Larry 8.
[AGENT][NEUTRAL] Thank you for that. And can you verify the member's first and last name and date of birth?
[CUSTOMER][NEUTRAL] [PII] [PII].
[AGENT][NEUTRAL] Thank you for that and all the information provided is a verification of benefits, not a guarantee of payment. I am showing that the policy is active. It's been effective since [PII]. And what type of benefits did you want to go over today?
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] I need to know if offices are covered inpatient outpatient benefits please.
[AGENT][NEUTRAL] You said you need to know if office visits are covered for inpatient and outpatient?
[CUSTOMER][NEUTRAL] I just need to know if the copay is covered and then I need inpatient outpatient benefits.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] So again just for the call, the information provided is a verification of benefits, not a guarantee of payment. So, um, the policy pays towards co-pays, deductible and co-insurance after primary or second to their primary. Um, outpatient benefits per calendar day is up to $500. I'm pulling up their, um,
[AGENT][NEUTRAL] Full policy now so that I can see if office visits are included in outpatient. Hold on one moment.
[CUSTOMER][NEUTRAL] Uh
[AGENT][NEUTRAL] Go ahead.
[CUSTOMER][NEUTRAL] You said $500 per calendar?
[AGENT][NEUTRAL] $500 per calendar day.
[CUSTOMER][NEUTRAL] Dane, OK, and then the inpatient?
[AGENT][NEUTRAL] Mhm.
[AGENT][NEUTRAL] Inpatient is 2500 per calendar year.
[CUSTOMER][NEUTRAL] 2500 per calendar year and has she met anything in any of them in combination?
[AGENT][NEUTRAL] Let's see, hold on one moment. OK, so for the office visits, the outpatient um portion of the policy does not cover in-office setting. Um, it's only for outpatient facilities, um, hospital emergency room, urgent care, outpatient surgeries, um, not the in-office setting, and
[AGENT][NEUTRAL] Let me see if anything has been used.
[AGENT][NEGATIVE] And for this year, um, none of the benefits have been used.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] For both, correct?
[AGENT][POSITIVE] Yes, correct.
[CUSTOMER][NEUTRAL] And you said the outpatient covers um.
[CUSTOMER][NEUTRAL] The um surgeries, correct?
[AGENT][NEUTRAL] Outpatient surgeries, yes. As long as it's in the hospital, um.
[CUSTOMER][NEUTRAL] OK, outpatient
[AGENT][NEUTRAL] Uh, uh, sorry, a free-standing outpatient surgery center or a hospital outpatient facility?
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] OK, and then the copays for office visits?
[AGENT][NEUTRAL] The policy doesn't cover office visits. The primary insurance may, but not the secondary.
[CUSTOMER][NEUTRAL] No, you can.
[CUSTOMER][POSITIVE] Got it, perfect. OK and uh is there a reference number for this call?
[AGENT][NEUTRAL] So there's no call reference number, but you can use my name in today's date. The first initial to my last name is [PII].
[CUSTOMER][POSITIVE] Perfect and thank you so much that's all I needed.
[AGENT][POSITIVE] You're very welcome and thanks for calling APL. I hope you have a great day.
[CUSTOMER][NEUTRAL] You too bye bye.
[AGENT][POSITIVE] Thank you. Bye-bye.