AccountId: 011433970860
ContactId: 7bd5ca4c-a295-43c5-8fd5-97505b5ce623
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 309089 ms
Total Talk Time (AGENT): 148217 ms
Total Talk Time (CUSTOMER): 79081 ms
Interruptions: 0
Overall Sentiment: AGENT=0.9, CUSTOMER=0.8
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/02/03/7bd5ca4c-a295-43c5-8fd5-97505b5ce623_20250203T18:36_UTC.wav
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[AGENT][NEUTRAL] Thank you for calling APL. This is [PII]. How can I help you?
[CUSTOMER][NEUTRAL] Hi [PII], my name is [PII]. I was calling to see if you could help me uh obtain some benefits for a patient, please.
[AGENT][POSITIVE] Yeah, I can check some benefits for you. um [PII], can I get a good call back number from you first in case we're disconnected?
[CUSTOMER][NEUTRAL] Yes, it's [PII].
[AGENT][NEUTRAL] Thank you. And then do you have the policy number?
[CUSTOMER][NEUTRAL] 17021941
[AGENT][NEUTRAL] Thank you and what was the name and date of birth for the insured?
[CUSTOMER][NEUTRAL] [PII], [PII].
[AGENT][NEUTRAL] I'm so sorry. I think I actually had an extra digit in that policy number, [PII], could you repeat that back to me?
[CUSTOMER][NEUTRAL] Oh.
[CUSTOMER][NEUTRAL] Yes, it's 17021941.
[AGENT][NEUTRAL] OK, yeah, that's uh one too many digits uh for one of our policy numbers. Let's see, do you have their social? I could search for them that way.
[CUSTOMER][NEUTRAL] I do not let me look through and see if I can find a different.
[AGENT][NEUTRAL] I could try just searching um.
[CUSTOMER][NEUTRAL] Um, this has a policy number completely different. Can you try 025?
[AGENT][NEUTRAL] Mhm.
[AGENT][POSITIVE] Yeah, that's right.
[AGENT][NEUTRAL] Uh-huh.
[CUSTOMER][NEUTRAL] 84103
[AGENT][NEUTRAL] That sounds more like one of ours, let's see.
[AGENT][NEUTRAL] I'm sorry, if you wouldn't mind repeating the name and date of birth for the member.
[CUSTOMER][NEUTRAL] I think they just
[CUSTOMER][NEUTRAL] [PII] [PII]
[AGENT][NEUTRAL] Perfect, thank you, yes, that was it. Alrighty, um, so this policy is active. Effective date was [PII], and this is a secondary medical policy, but it is designed to help with co-pay, deductible and co-insurance after major medical pays, and we really need to look at the outpatient benefits.
[CUSTOMER][NEUTRAL] That's 2, OK.
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] Um, I'm looking for, yes, outpatient for a specialty office visit.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] Office visit, OK, give me just a moment let me get all this pulled up here.
[AGENT][NEUTRAL] Alright, and of course I will let you know verification of coverage is not a guarantee of payment for claims. So under this policy office visits are not covered, however, treatment received in office could be. So if it was simply like a consultation, um, that would not be covered, but if treatment was received, that could be.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK, so if she was to need an inpatient surgical procedure done in the office.
[CUSTOMER][NEUTRAL] Would she be able to get some coverage?
[AGENT][NEUTRAL] Oh, that's interesting. You mm, an inpatient in office.
[CUSTOMER][NEUTRAL] Outpatients in office.
[AGENT][NEUTRAL] Oh, outpatient in office. Uh, let me check that. I believe so, um, but let me double check. I'm just gonna get that policy pulled up.
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][POSITIVE] OK, thank you.
[AGENT][NEUTRAL] OK. So, yes, uh, for the outpatient benefit, it does state surgery uh in a hospital outpatient facility, freestanding outpatient surgery center, or a physician's office.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] So that is covered under the outpatient benefit.
[CUSTOMER][NEUTRAL] OK, what would her coverage be?
[AGENT][NEUTRAL] Uh, let me get that dollar amount. Let's see.
[AGENT][NEUTRAL] OK, so that outpatient benefit is $3000 per covered person per calendar year and that is gonna be combined with that is inpatient and outpatient. It is a combined benefit per calendar year. um, give me just a moment I will double check to see if any of that has been used.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][POSITIVE] Thank you.
[AGENT][NEUTRAL] OK, none has been used so far this year.
[CUSTOMER][POSITIVE] Nothing yet. OK, perfect, thank you.
[CUSTOMER][NEUTRAL] OK, so do you have a reference number for me?
[AGENT][NEUTRAL] It would just be my first name, last initial, and today's date, uh, so my name is spelled [PII] last initial is [PII] Was there anything else I could help you with, [PII]?
[CUSTOMER][NEUTRAL] OK
[CUSTOMER][NEUTRAL] Uh-huh.
[CUSTOMER][NEUTRAL] OK
[CUSTOMER][POSITIVE] Um, no, that's it. Thank you, [PII].
[AGENT][POSITIVE] OK, yeah, thanks for calling APL. I hope you have a great rest of your day.
[CUSTOMER][NEUTRAL] You too.
[AGENT][POSITIVE] Thank you. Bye-bye.