AccountId: 011433970860
ContactId: 7cd965cf-31a0-43df-98ac-666bb7253445
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 519900 ms
Total Talk Time (AGENT): 160883 ms
Total Talk Time (CUSTOMER): 67247 ms
Interruptions: 0
Overall Sentiment: AGENT=0.7, CUSTOMER=-0.9
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/04/10/7cd965cf-31a0-43df-98ac-666bb7253445_20250410T15:18_UTC.wav
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[AGENT][NEUTRAL] Good morning. Thank you for calling APL. This is [PII]. How may I assist you?
[CUSTOMER][NEUTRAL] Hi, I'm calling from provider's office trying to verify benefits on the patient.
[AGENT][POSITIVE] OK, sure. I can assist you with benefits. And may I have your name?
[CUSTOMER][NEUTRAL] My name is [PII] with advanced dermatology.
[AGENT][NEUTRAL] OK, thank you, Mr. [PII], and may I have a callback number just in case we get disconnected?
[CUSTOMER][NEUTRAL] [PII]
[AGENT][NEUTRAL] Thank you. Do you have the policy number of the patient, Miss?
[CUSTOMER][NEUTRAL] 02579768
[AGENT][POSITIVE] Thank you.
[AGENT][NEUTRAL] What's the name and date of birth of the patient?
[CUSTOMER][NEUTRAL] [PII] [PII].
[AGENT][NEUTRAL] OK. Thank you, Ms. [PII]. Um, let me see if I can find the medical plan. That one was the dental. Let me pull, um.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Yeah, I wasn't sure if that was who they were. It says group voluntary dental on the card.
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] But I didn't know if maybe that's just a good group name somewhere where they work or something.
[AGENT][POSITIVE] Exactly.
[AGENT][NEUTRAL] No, it's fine. I can pull any other policies they have. So, um, yeah, I see that he has a limited hospital indemnity plan as well. Um, and this is gonna be for testing done in the office or what type of service is being rendered.
[CUSTOMER][NEUTRAL] No, no medical benefits, um, we're dermatologists. So this is just dental and hospital indemnity.
[AGENT][NEUTRAL] Mhm.
[AGENT][NEUTRAL] Um, yeah, it does have the additional benefits. That's why I'm asking what type of service is being rendered, so I can determine if, if it's something that it is covered under the policy. So, is this for testing or is this like just an office, a specialist visit or what type of service?
[CUSTOMER][NEUTRAL] Uh
[CUSTOMER][NEUTRAL] Uh, specialist offices at surgery in the office and lab work in the office. Um, we're a dermatologists.
[AGENT][NEUTRAL] OK, um, bear with me just a second, let me see what benefits we have here.
[AGENT][NEUTRAL] OK, and this is not a guarantee of payment, just a verification of coverage. Uh let's see.
[AGENT][NEUTRAL] Yeah, I do see has surgical benefits. Bear with me just a second. I just need to pull the paperwork instead.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] All right, here it is.
[AGENT][NEUTRAL] Mm.
[AGENT][NEUTRAL] Mm.
[AGENT][NEUTRAL] Uh, do you mind holding for me just a second? I just need to, um, find out because, um, I see something a little bit different on the paperwork that I see on the computer. Do you mind holding for me?
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] OK, thank you. One moment.
[CUSTOMER][NEUTRAL] That's fine.
[CUSTOMER][NEGATIVE] You are on hold.
[CUSTOMER][NEGATIVE] You are on hold.
[CUSTOMER][NEGATIVE] You are on hold.
[CUSTOMER][NEUTRAL] You
[AGENT][NEUTRAL] Thank you for holding and being patient for me, Miss [PII]. OK, so, yeah, we're gonna go by the certificate. So, under the certificate of the policy, uh, no, there's no benefits for surgery. Um, the only thing that it looks like it will probably cover will be the office visit. Um, but that's all that I see here that it may qualify for, um, which is $75 per day, up to 6 visits per year.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK. And do you know if they've used any of those 6 visits?
[AGENT][NEUTRAL] I can check for you. Let's see.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] All right.
[AGENT][NEUTRAL] As of today, he has not used his benefits for [PII], so he still has all 6 available.
[CUSTOMER][NEUTRAL] OK. And do you give reference numbers?
[AGENT][NEUTRAL] We don't have reference numbers. You can use my name in today's date if you will. Um, do you need the spelling of my name or any other information? Do you need the policy number? I think you had the wrong policy number in the beginning.
[CUSTOMER][NEUTRAL] Oh yes. Can I, can I get the correct policy number?
[AGENT][NEUTRAL] Yes, uh-huh. Uh, the policy number is 25798887.
[CUSTOMER][NEUTRAL] OK. And what was your name again?
[AGENT][NEUTRAL] My name is [PII]. That's [PII].
[CUSTOMER][POSITIVE] All right, thank you very much.
[AGENT][POSITIVE] You're welcome and thank you for calling APL. You have a good day, Ms. [PII].
[CUSTOMER][NEUTRAL] You