AccountId: 011433970860
ContactId: 794285ff-da31-414e-86ce-27cbe4308529
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 170690 ms
Total Talk Time (AGENT): 66609 ms
Total Talk Time (CUSTOMER): 97662 ms
Interruptions: 1
Overall Sentiment: AGENT=0.6, CUSTOMER=0.9
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/04/29/794285ff-da31-414e-86ce-27cbe4308529_20250429T19:06_UTC.wav
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[AGENT][NEUTRAL] Calling APL, my name is [PII]. How can I assist you today?
[CUSTOMER][NEUTRAL] I
[CUSTOMER][NEUTRAL] Hi [PII]. My name is [PII]. I was calling for benefits and eligibility.
[AGENT][POSITIVE] I'd be happy to assist with benefits and eligibility today [PII], if I can get a good call back number for you.
[CUSTOMER][NEUTRAL] Sure, um, it will be for specialist office visit and the callback number is [PII].
[AGENT][NEUTRAL] And what is the policy number?
[CUSTOMER][NEUTRAL] It is 60801.
[AGENT][NEUTRAL] That's our payer ID. Do you have a social?
[CUSTOMER][NEUTRAL] All right
[CUSTOMER][NEUTRAL] It is I'm looking at this like wait a minute that doesn't look right um sure let's see.
[CUSTOMER][NEUTRAL] I have a group number an effective date. I have the plan type. I have an in hospital benefits cert number and an outpatient benefits cert number.
[AGENT][NEUTRAL] Give me the outpatient.
[CUSTOMER][NEUTRAL] I'm not sure
[CUSTOMER][NEUTRAL] Sure it's 0238887.
[CUSTOMER][NEUTRAL] 38 ML 8.
[AGENT][NEUTRAL] Patient's name and date of birth.
[CUSTOMER][NEUTRAL] Her name is [PII]. Her date of birth is [PII].
[AGENT][NEUTRAL] Thank you for that information. Please be advised the verification of coverage is not a guarantee of payment. I do show the policy is currently active. Effective date is [PII], and I do show for outpatient specialist office visit.
[CUSTOMER][POSITIVE] No problem.
[AGENT][NEUTRAL] That will be covered under the outpatient benefit which is $500 per day.
[CUSTOMER][NEUTRAL] And
[CUSTOMER][NEUTRAL] we have a new one.
[AGENT][NEUTRAL] And only the treatment and procedures that the visit will be covered. The copay associated with the visit is not covered.
[CUSTOMER][NEUTRAL] OK, so that's only for treatments and procedures and that's up to $500 per day.
[AGENT][NEUTRAL] Per day.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] And when we had to have to submit claims to you guys first?
[AGENT][NEUTRAL] No, they would go to her, um, primary first and then the EOB and the claim would come to us second.
[CUSTOMER][NEUTRAL] Right, I mean, yeah, first like, yeah, first to the primary then secondary so should we wait to submit to you um to see like what it would pay out like any discounts and stuff like that?
[AGENT][NEUTRAL] Right, it's gonna go to her primary first and then when they send you back the EOB then you would file with us.
[CUSTOMER][NEUTRAL] 33
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] And then send us the EOB as well.
[CUSTOMER][NEUTRAL] OK, got you.
[CUSTOMER][NEUTRAL] Right, OK, alright, do you have a reference number for this call?
[AGENT][NEUTRAL] Reference is just my name [PII] last initial [PII], and the date and time of the call. Was there anything else I could assist with?
[CUSTOMER][POSITIVE] OK, perfect.
[CUSTOMER][NEUTRAL] No, that's it.
[AGENT][POSITIVE] Thank you for calling APL you have a good day.
[CUSTOMER][POSITIVE] Thank you you as well bye.
[AGENT][NEUTRAL] Mhm. Bye bye.
[CUSTOMER][POSITIVE] Correct.