AccountId: 011433970860
ContactId: 7d9e57df-f54d-4abc-8328-d2b44148fdc1
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 226990 ms
Total Talk Time (AGENT): 100098 ms
Total Talk Time (CUSTOMER): 59583 ms
Interruptions: 1
Overall Sentiment: AGENT=1.2, CUSTOMER=1.1
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/05/19/7d9e57df-f54d-4abc-8328-d2b44148fdc1_20250519T15:21_UTC.wav
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[AGENT][NEUTRAL] Thank you for calling APL. This is [PII]. How can I help you?
[CUSTOMER][NEUTRAL] I mean I just need to get eligibility on a patient.
[AGENT][POSITIVE] Sure, I can help you with eligibility. Can I get your name and a good callback number?
[CUSTOMER][NEUTRAL] Yes, it's [PII], and my callback number is [PII] and my extension is [PII].
[AGENT][POSITIVE] Thank you so much, [PII]. Can I get the policy number?
[CUSTOMER][NEUTRAL] Um, yes, it is, um, 02579329.
[AGENT][NEUTRAL] Alright, one moment while I look that up.
[CUSTOMER][POSITIVE] Thank you.
[AGENT][NEUTRAL] And can I get you to verify the patient's name and date of birth?
[CUSTOMER][NEUTRAL] Um, yes, it's [PII]. Date of birth is [PII].
[AGENT][POSITIVE] OK, thank you so much.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] Alright, [PII], I am showing that this policy is active with an effective date of [PII].
[CUSTOMER][NEUTRAL] OK. Now, this, um, OK, OK. So, all right. And um are the benefits um like for surgery, can I get those for outpatient surgery for professional fees?
[AGENT][NEUTRAL] Sure, let me pull up that policy real quick and I'll get you those benefits. Um, I do want to say that this is a verification of benefits and not necessarily a guarantee of payment. Also, this is a Medlink policy, which is a secondary gap policy, so we will need the major medicals, um.
[CUSTOMER][POSITIVE] All right, thank you.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] EOB first.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] To show that benefits have been paid because if they deny the claim, then this claim, then uh this policy will not.
[AGENT][NEUTRAL] Pick up.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] So let me see real quick.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] It looks like there is an outpatient benefit maximum of up to $10,500 for all covered persons.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] Um, it is an outpatient benefit maximum of 3 up to $3500 per person.
[AGENT][NEUTRAL] And you are wanting to know about surgery specifically?
[CUSTOMER][NEUTRAL] Uh huh, yes, benefits, yeah, for, um, yeah.
[AGENT][NEUTRAL] It looks like there is an out, oh, go ahead.
[CUSTOMER][NEUTRAL] Go ahead, no, no, that's OK, go ahead.
[AGENT][NEUTRAL] OK. Yes, there is an outpatient benefit um towards that, uh, 3500 surgery in an outpatient or in a hospital outpatient facility, freestanding surgery center, um, physician's office.
[CUSTOMER][POSITIVE] OK. All right. OK. All right, thank you so much.
[AGENT][NEUTRAL] Alright, is there anything else I can help you with?
[CUSTOMER][NEUTRAL] Um, no, that's it.
[AGENT][POSITIVE] All right, well, thank you so much for calling APL and I hope you have a great day.
[CUSTOMER][POSITIVE] Thanks you too bye bye.
[AGENT][NEUTRAL] Bye.