AccountId: 011433970860
ContactId: 7f4f953a-f5eb-4cea-bb5d-d96201bc9f3e
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 179039 ms
Total Talk Time (AGENT): 81428 ms
Total Talk Time (CUSTOMER): 59735 ms
Interruptions: 0
Overall Sentiment: AGENT=1.7, CUSTOMER=0.9
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/03/11/7f4f953a-f5eb-4cea-bb5d-d96201bc9f3e_20250311T20:58_UTC.wav
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[AGENT][POSITIVE] Good afternoon. Thank you for calling APL. My name is [PII]. How may I help you?
[CUSTOMER][NEUTRAL] Hey [PII], my name is [PII]. That is spelled [PII] I'm calling for patients eligibility and benefits.
[AGENT][POSITIVE] OK, I'll be more than happy to assist you with the eligibility and benefits, and [PII], may I have a good contact number in case we're disconnected?
[CUSTOMER][NEUTRAL] Yeah, that'll be [PII].
[AGENT][NEUTRAL] Thank you. May I have the member's policy number?
[CUSTOMER][NEUTRAL] Yes, I have here 1475057, M as in Mike, L as in Larry, and the number 7.
[AGENT][NEUTRAL] Thank you for that. And can you verify the member's first and last name and date of birth?
[CUSTOMER][NEUTRAL] Yeah, so it's gonna be [PII] [PII].
[AGENT][NEUTRAL] Thank you for that and all the information provided is a verification of benefits, not a guarantee of payment. So this particular policy um was active from [PII]. There is an active policy though.
[CUSTOMER][NEUTRAL] Oh
[AGENT][NEUTRAL] There has been a
[CUSTOMER][NEUTRAL] Oh, what is that the policy?
[AGENT][NEUTRAL] That has been effective since [PII].
[AGENT][NEUTRAL] The policy number is 2502635.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] 2502635. OK.
[CUSTOMER][NEUTRAL] And uh would this cover, uh, I, I know that this is a gap insurance and it'll have outpatient coverage per calendar year. um, would it cover uh primary care offices?
[AGENT][NEUTRAL] Um, hold on one moment, let me take a look.
[AGENT][NEUTRAL] So the policy itself, like for like the facility charge or place of service charge, there's no coverage for office visits, but the insured does have the office treatment rider.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] Um, in which any treatment in the office as long as it's not cosmetic, could be covered up to that $2500 per calendar year.
[CUSTOMER][NEUTRAL] OK, has the member used any of the 2500 this year?
[AGENT][NEUTRAL] Hold on one moment.
[AGENT][NEUTRAL] Um, no, they have not used any of the benefits for [PII].
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Alright, [PII], all I would need now is a reference number and I'll be on my way.
[AGENT][NEUTRAL] Alright, so there's no card reference number, but you can use my name in today's date. The first initial to my last name is [PII].
[CUSTOMER][NEUTRAL] Mm.
[CUSTOMER][POSITIVE] Thank you [PII] you have yourself a wonderful rest of your day.
[AGENT][POSITIVE] You also [PII] thanks for calling APL. I hope you have a great day.
[CUSTOMER][POSITIVE] Thank you.
[AGENT][POSITIVE] Thank you. Bye-bye.