AccountId: 011433970860
ContactId: 705f95fb-e954-44d3-b3c5-4d1f5d8544ed
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 289339 ms
Total Talk Time (AGENT): 78670 ms
Total Talk Time (CUSTOMER): 112484 ms
Interruptions: 0
Overall Sentiment: AGENT=1, CUSTOMER=1.3
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/06/09/705f95fb-e954-44d3-b3c5-4d1f5d8544ed_20250609T17:15_UTC.wav
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[AGENT][POSITIVE] Thanks for calling APL. This is [PII]. How can I help you?
[CUSTOMER][NEUTRAL] Hi, [PII]. This is [PII] from doctor's office. I have a patient you want to uh check the eligibility and benefits for specialist office visit.
[AGENT][NEUTRAL] OK, [PII], I can check uh eligibility. Do you have a good callback number?
[CUSTOMER][NEUTRAL] [PII] direct line?
[AGENT][NEUTRAL] And policy number for that patient?
[CUSTOMER][NEUTRAL] Yes, the policy number is starting from 02027773ML8.
[AGENT][NEUTRAL] Patient name and date of birth?
[CUSTOMER][NEUTRAL] Yes, of course. The patient name is [PII] and date of birth is [PII].
[CUSTOMER][NEUTRAL] I
[AGENT][NEUTRAL] OK. Give me just one moment.
[CUSTOMER][NEUTRAL] You
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] OK, looks like that's an old policy that terminated in April. Let me give you the new policy number.
[AGENT][NEUTRAL] That's 261-158-5.
[AGENT][POSITIVE] And for this policy, uh, this policy is effective.
[AGENT][NEUTRAL] [PII] it's currently active.
[AGENT][NEUTRAL] And you say benefits for the office visit, is that right?
[CUSTOMER][NEUTRAL] Yes, for specialist office visit.
[AGENT][NEUTRAL] It's not a guarantee of payment. It's a basic outline of the policy.
[AGENT][NEUTRAL] Um, let me get that pulled up.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Yeah.
[AGENT][NEUTRAL] Uh, it looks like the benefits for this policy.
[AGENT][NEUTRAL] Uh, pays 3,575 per calendar year.
[AGENT][NEUTRAL] And
[AGENT][NEUTRAL] That's just gonna be for outpatient services. There's not an offices benefit.
[CUSTOMER][NEUTRAL] Ship services.
[CUSTOMER][NEUTRAL] Outpatient services. And uh also what is the net amount from 3,525?
[AGENT][NEUTRAL] Uh, they've not used anything. Nothing's been that.
[CUSTOMER][NEUTRAL] OK, and uh I also want to know that if the service is performed by the specialist in office like infusions or any other services are covered under this patient plan or not?
[AGENT][NEUTRAL] Uh, no, they won't be covered in office. It would have to be in an outpatient hospital facility.
[CUSTOMER][NEUTRAL] OK. And uh if the primary insurance left some responsibility against the co-pay deductibles or co-insurance are covered?
[AGENT][POSITIVE] Yes, as an outpatient hospital services. Yes, that's correct.
[CUSTOMER][POSITIVE] I appreciate.
[CUSTOMER][NEUTRAL] services.
[CUSTOMER][NEUTRAL] Also, please provide me the group number for billing purpose.
[AGENT][NEUTRAL] My group number is.
[AGENT][NEUTRAL] 239-02.
[CUSTOMER][NEUTRAL] 02
[CUSTOMER][NEUTRAL] OK, and the uh payer ID goes to?
[AGENT][NEUTRAL] 60801.
[CUSTOMER][NEUTRAL] You said.
[CUSTOMER][NEUTRAL] 60801.
[CUSTOMER][POSITIVE] OK, thank you so much. Now, the uh uh new member ID is 2611585. Am I correct?
[AGENT][POSITIVE] Yes, that's right.
[CUSTOMER][POSITIVE] Thank you so much. Please provide me the call reference number kindly.
[AGENT][NEUTRAL] A call reference number is my name, [PII], first initial to last name [PII] as in Delta, and today's date.
[CUSTOMER][POSITIVE] D as in Delta. Thank you so much, [PII], for providing me this useful information. Have a nice day. Take care.
[AGENT][POSITIVE] Thank you for calling APL you too bye bye.