AccountId: 011433970860
ContactId: 81edefb2-f78b-4000-990e-8af8e97122fe
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 178259 ms
Total Talk Time (AGENT): 89469 ms
Total Talk Time (CUSTOMER): 52330 ms
Interruptions: 1
Overall Sentiment: AGENT=0.9, CUSTOMER=0.6
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/06/11/81edefb2-f78b-4000-990e-8af8e97122fe_20250611T14:26_UTC.wav
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[AGENT][NEUTRAL] Thank you for calling APL. This is [PII]. How can I help you?
[CUSTOMER][NEUTRAL] Yes, hi, my name is [PII]. I'm calling from Texas Oncology Doctor [PII]'s office. I'm trying to verify eligibility and benefits for a member.
[AGENT][NEUTRAL] OK, I could check eligibility and benefits for you. I'm sorry, did you say your name was [PII]?
[CUSTOMER][POSITIVE] Thank you.
[CUSTOMER][NEUTRAL] Yes.
[AGENT][NEUTRAL] OK, uh, can I get a good call back number from you first in case we're disconnected please?
[CUSTOMER][NEUTRAL] It's [PII].
[AGENT][NEUTRAL] Got it, thank you. And then do you have that policy number?
[CUSTOMER][NEUTRAL] Yes, I have 01868782.
[AGENT][NEUTRAL] OK and then what was the name and date of birth for the member please?
[CUSTOMER][NEUTRAL] Yes, [PII], on [PII].
[AGENT][NEUTRAL] Perfect thank you for verifying that. So the policy is active. Effective date was [PII], and this is a secondary medical policy, so it is designed to help with co-pay, deductible and co-insurance after major medical pays, and we're really need to look at inpatient or outpatient benefits for this member.
[CUSTOMER][NEUTRAL] Outpatient, she's going to be um.
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Let me see, we're needing benefits for chemotherapy.
[AGENT][NEUTRAL] Chemo, OK, um, what kind of, uh, is this going to be performed in an office setting?
[CUSTOMER][NEUTRAL] Office setting, yes.
[AGENT][NEUTRAL] OK, perfect. Alright, and I will let you know verification of coverage is not a guarantee of payment for claims, so the outpatient benefit is $2550 per calendar year and that does include cancer treatment received in office. And if you'll give me one moment, I will see if any of that benefit has been used.
[CUSTOMER][NEUTRAL] OK
[AGENT][NEUTRAL] All right, one moment.
[AGENT][NEUTRAL] Alright, so it does look like for this year she has met that maximum benefit amount for outpatient.
[CUSTOMER][NEUTRAL] OK, so then that's it, she won't have any, any more coverage, right?
[AGENT][NEUTRAL] Correct, uh, until January, that's correct.
[CUSTOMER][NEUTRAL] For the rest of the year until next year.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Alright, let me make a note of that.
[CUSTOMER][NEUTRAL] All right and uh what is your name? I'm sorry?
[AGENT][NEUTRAL] It's OK, uh, [PII]
[AGENT][NEUTRAL] Was there anything else I could help you with?
[CUSTOMER][POSITIVE] That's all thank you so much for your help.
[AGENT][POSITIVE] Alright, yeah, thanks for calling APL have a great rest of your day.
[CUSTOMER][NEUTRAL] You too bye bye.
[AGENT][POSITIVE] Thank you bye bye