AccountId: 011433970860
ContactId: 7b411e48-ec3c-4160-819d-06b62cb8e9a2
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 478239 ms
Total Talk Time (AGENT): 121573 ms
Total Talk Time (CUSTOMER): 99724 ms
Interruptions: 0
Overall Sentiment: AGENT=0.9, CUSTOMER=1.7
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/02/18/7b411e48-ec3c-4160-819d-06b62cb8e9a2_20250218T22:59_UTC.wav
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[AGENT][NEUTRAL] Thank you for calling APL this is [PII]. How may I help you?
[CUSTOMER][NEUTRAL] Hi [PII], good afternoon, um, just to make sure I have your name spelled correctly is [PII]
[AGENT][NEUTRAL] [PII]
[CUSTOMER][NEUTRAL] OK, sorry, and the initial of your last name?
[AGENT][NEUTRAL] That's OK. A.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Let's see.
[AGENT][NEUTRAL] And what is your name?
[CUSTOMER][NEUTRAL] Let's see
[CUSTOMER][NEUTRAL] Uh, yes, my name is [PII]. I'm calling from the provider's office.
[AGENT][NEUTRAL] OK, [PII], can you please give me the name of the provider and your callback number?
[CUSTOMER][NEUTRAL] Uh, yeah, so it's gonna be called Ortho now. The callback number is [PII].
[AGENT][POSITIVE] Thank you, ma'am.
[AGENT][POSITIVE] And how can I help you today?
[CUSTOMER][NEUTRAL] Uh yes, I was just calling in regards to a mutual patient for [PII]. I can give you his date of birth.
[AGENT][NEUTRAL] Yes, can you give me his date of birth and his policy number, please?
[CUSTOMER][NEUTRAL] Yes, I have [PII].
[CUSTOMER][NEUTRAL] And then the policy number I have is 02216489 M as in Mary L as in lollipop 8.
[AGENT][NEUTRAL] OK, let me pull in that policy for you.
[CUSTOMER][NEUTRAL] Of course and if you don't mind, can I just put you on one moment hold?
[AGENT][NEUTRAL] Yes, that's fine.
[CUSTOMER][POSITIVE] Thank you, just one moment.
[CUSTOMER][NEUTRAL] Hello?
[AGENT][NEUTRAL] Hello, I'm still here.
[CUSTOMER][POSITIVE] Hi, thank you so much for holding I appreciate it um alrighty and then was there anything else that you needed for the patient?
[AGENT][NEUTRAL] No, I just need to know um are you calling for benefits and elig eligibility or?
[AGENT][NEUTRAL] Did you wanna look up a claim? OK.
[CUSTOMER][NEUTRAL] Yes, I'm calling, yes.
[CUSTOMER][NEUTRAL] Yeah.
[AGENT][NEUTRAL] Alright, so the patient is eligible. The um effective date of the policy is [PII] and it's active and if you give me your fax number I can send you a fax back with the complete benefit breakdown.
[CUSTOMER][NEUTRAL] We just transfer.
[CUSTOMER][NEUTRAL] OK, so sorry, repeat that one more time.
[AGENT][NEUTRAL] The patient is um active. The effective date is [PII].
[CUSTOMER][NEUTRAL] OK yeah.
[AGENT][NEUTRAL] And if you give me your fax number I can send you, no, I can't, you're not a dentist office, huh, OK, sorry about that. I saw the ortho now and I thought it was a dental. OK, this is just to verify the benefits. It's not a guarantee of payment. This is a supplemental insurance policy that's billed secondary to the primary major medical insurance.
[AGENT][NEUTRAL] It helps with deductible, co-pay or co-insurance. The insured has an inpatient benefit calendar year amount of $1000 and they also has a benefit of outpatient per calendar day amount of $200.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK, so that you said that's for the outpatient benefit amount, the $200?
[AGENT][NEUTRAL] Yes, and this is a medical policy.
[CUSTOMER][NEUTRAL] OK, and then the other one you're saying was for what specifically sorry?
[AGENT][NEUTRAL] Inpatient amount is $1000.
[CUSTOMER][NEUTRAL] Oh.
[CUSTOMER][NEUTRAL] Inpatient, OK.
[CUSTOMER][NEUTRAL] And then just to confirm, so specifically for an urgent care clinic, you guys cover the deductible and copay from the primary funding United Healthcare.
[AGENT][NEUTRAL] Yes, up to $200 for outpatient.
[CUSTOMER][NEUTRAL] Oh OK got you.
[CUSTOMER][POSITIVE] Alrighty.
[CUSTOMER][NEUTRAL] Perfect. And then for the call reference number, is it your name on today's date?
[AGENT][NEUTRAL] Yes ma'am.
[CUSTOMER][POSITIVE] Alrighty, perfect. Have they, um, accumulated any of that $200 out of pocket?
[AGENT][NEUTRAL] Let me look and see.
[AGENT][NEGATIVE] No, nothing has been used for the year of [PII].
[CUSTOMER][POSITIVE] OK perfect I appreciate your help so much.
[AGENT][POSITIVE] You're very welcome, [PII]. Is there anything else I can help you with before we go?
[CUSTOMER][POSITIVE] No, that's it thank you you have a great day.
[AGENT][POSITIVE] You're you're welcome you have a good day too. Thanks for calling APL.
[CUSTOMER][POSITIVE] Thank you, bye.
[AGENT][NEUTRAL] Bye bye.