AccountId: 011433970860
ContactId: 7e67ad1d-67cc-48cc-9567-5a4bc1673a17
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 231100 ms
Total Talk Time (AGENT): 106234 ms
Total Talk Time (CUSTOMER): 80474 ms
Interruptions: 1
Overall Sentiment: AGENT=2.1, CUSTOMER=0
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/04/23/7e67ad1d-67cc-48cc-9567-5a4bc1673a17_20250423T16:37_UTC.wav
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[AGENT][POSITIVE] Thanks for calling APL. This is [PII]. How may I assist you?
[CUSTOMER][NEUTRAL] Hello?
[CUSTOMER][NEUTRAL] Hello?
[AGENT][NEUTRAL] Hello, thanks for calling APL. This is [PII]. How may I assist you?
[CUSTOMER][NEUTRAL] Hi, I need to um verify benefits and eligibility for a patient, please.
[AGENT][POSITIVE] Sure, I can assist you with that. Can I have your name and a callback number?
[CUSTOMER][NEUTRAL] My name is [PII], [PII].
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] Thank you. And what's the policy number of the member that you're calling to verify benefits for today?
[CUSTOMER][NEUTRAL] 02
[CUSTOMER][NEUTRAL] 4657
[CUSTOMER][NEUTRAL] 50 M like Mary L like Larry.
[CUSTOMER][NEUTRAL] And the number 8.
[AGENT][NEUTRAL] Can you verify the patient's name and date of birth?
[AGENT][POSITIVE] I'll be able to assist you.
[CUSTOMER][NEUTRAL] [PII].
[CUSTOMER][NEUTRAL] 22668.
[AGENT][POSITIVE] Thank you [PII], so let me give you the correct policy number.
[AGENT][NEUTRAL] Let me know when you're ready for work.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Go ahead.
[AGENT][NEUTRAL] It is 214-084-3. It's 214-084-3. This policy has been active since [PII] and it's currently active. You're calling to verify benefits eligibility for what place of service for [PII]?
[CUSTOMER][NEUTRAL] Um, place of service um 02.
[AGENT][NEUTRAL] Is it inpatient, outpatient office visit?
[CUSTOMER][NEUTRAL] Outpatient office visit outpatient.
[AGENT][NEUTRAL] So this member policy has outpatient benefits of $7900 per calendar year and the treatment received in the office.
[CUSTOMER][NEGATIVE] I'm sorry, you cut up.
[AGENT][NEUTRAL] So this member's policy has $7900 per calendar year for treatment received in the office or outpatient services and the office visits is $25 per visit up to $50 for a specialist with 4 visits per calendar year and this is not a guarantee of benefits, just a disclaimer of the policy's coverage.
[CUSTOMER][NEGATIVE] You're cutting, I'm sorry.
[CUSTOMER][NEUTRAL] Uh-huh.
[AGENT][NEUTRAL] Were you able to hear all of that?
[CUSTOMER][NEUTRAL] OK, so I'm gonna repeat it back to you. So he has available $7900 for calendar year.
[CUSTOMER][NEUTRAL] His um co-pay.
[CUSTOMER][NEUTRAL] is anywhere between $25 to $50 and he has up to 4 visits per year.
[AGENT][NEUTRAL] Yes, that is correct. That is for the office visits, but the procedures completed in the office falls under the $7900 per calendar year, and this is not a guaranteed benefits, just a disclaimer of the policy's coverage, meaning as any procedure that's performed in the doctor's office falls under the outpatient benefits.
[CUSTOMER][NEUTRAL] Meaning
[CUSTOMER][NEUTRAL] OK, so if it's just for an office, so if it's an office visit, per se, just a regular office visit, telehealth, for telehealth services, it's $25 to $50 that you will cover.
[AGENT][POSITIVE] Yes, that is correct.
[CUSTOMER][NEUTRAL] That you will, that he has a co-pay, you'll cover the remaining.
[AGENT][POSITIVE] That is correct.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] And how do I know which co-pay applies, whether it's 25 or 50?
[AGENT][NEUTRAL] If it's a specialist office visit, it would be 50. If it's not a specialist office visit, then it's gonna be 25. I'm not sure which one you would be considered as until we receive a claim.
[CUSTOMER][POSITIVE] OK. All right. I appreciate your help. Thank you.
[AGENT][NEUTRAL] Is there anything else that I can assist you with today, [PII]?
[CUSTOMER][POSITIVE] No, that would be it. Thank you.
[AGENT][POSITIVE] You're welcome thanks for calling APL and have a great day.
[CUSTOMER][NEUTRAL] Bye bye.