AccountId: 011433970860
ContactId: 7bda3892-5f33-45d4-a0e3-a7841ac55fa4
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 195449 ms
Total Talk Time (AGENT): 93446 ms
Total Talk Time (CUSTOMER): 60735 ms
Interruptions: 0
Overall Sentiment: AGENT=0.2, CUSTOMER=0.6
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/06/04/7bda3892-5f33-45d4-a0e3-a7841ac55fa4_20250604T20:49_UTC.wav
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[AGENT][NEUTRAL] Good afternoon. Thank you for calling APL. This is [PII]. May I help you?
[CUSTOMER][NEUTRAL] Yes, this is East Georgia Gastroenterology Institute and I need to verify coverage.
[AGENT][NEUTRAL] OK, I can verify benefits and eligibility for you and I apologize, your name is again?
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] OK, and Ms. [PII], what is the policy number, please?
[CUSTOMER][NEUTRAL] 02469142
[AGENT][NEUTRAL] OK, thank you and do you have a callback number in case the call drops?
[CUSTOMER][NEUTRAL] Yes ma'am, [PII].
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] Thank you. And the patient's name, date of birth?
[CUSTOMER][NEUTRAL] [PII] Date of birth [PII].
[AGENT][NEUTRAL] OK, thank you. I'm showing her effective date is [PII], and she is active on the policy.
[CUSTOMER][NEUTRAL] Oh.
[AGENT][NEUTRAL] And what benefits you're needing for this patient?
[CUSTOMER][NEUTRAL] Um, I need to know what her, um.
[CUSTOMER][NEUTRAL] Her limits are and if we're in network with her benefits and if she has a copay.
[AGENT][NEUTRAL] OK, uh, no, ma'am, the.
[AGENT][NEUTRAL] Our company, we don't have a network and the type of policy she has is a limited medical indemnity plan, um, so there's no deductible, co-pay or co-insurance. It's just a max we would pay for coverage services.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Yeah
[CUSTOMER][NEUTRAL] OK, and what's that max?
[AGENT][NEUTRAL] And what
[AGENT][NEUTRAL] It depends on the procedure or what it, what benefits are needing this for an office visit, surgery, outpatient?
[CUSTOMER][NEUTRAL] Yeah, it's an office visit.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] Um, see.
[CUSTOMER][NEUTRAL] Mhm
[AGENT][NEUTRAL] Uh, not a guarantee of payment, just a verification of coverage. For an office visit, the max we pay is up to $75 per visit, and she has a total of 6 visits per year.
[CUSTOMER][NEUTRAL] And how many visits has she used?
[AGENT][NEUTRAL] Uh let's see.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] Oh.
[AGENT][NEUTRAL] Um, Miss [PII].
[AGENT][NEUTRAL] Uh, so far shows she's used 2, so she has 4 remaining for this year.
[CUSTOMER][NEUTRAL] the coronavirus um.
[CUSTOMER][NEUTRAL] that.
[CUSTOMER][NEUTRAL] And does your um do you send the money directly to her?
[AGENT][NEUTRAL] Uh, if benefits are assigned, um, we do pay the provider.
[CUSTOMER][NEUTRAL] OK, alright, that's all I needed to know and can I get a reference number?
[AGENT][NEUTRAL] Uh, if you like, you may use my name at today's date, and it's [PII] last initial [PII]
[CUSTOMER][NEUTRAL] Yeah
[CUSTOMER][NEUTRAL] Hm
[CUSTOMER][NEUTRAL] Right
[CUSTOMER][POSITIVE] All right, thank you [PII].
[AGENT][POSITIVE] All right, you're welcome. Thank you for calling APL, Miss [PII]. Have a great day.
[CUSTOMER][POSITIVE] All right bye bye you too bye bye.
[AGENT][NEUTRAL] Bye.