AccountId: 011433970860
ContactId: 828fac0c-311d-4493-aba8-57bd3f7d6f9a
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 184690 ms
Total Talk Time (AGENT): 70153 ms
Total Talk Time (CUSTOMER): 78318 ms
Interruptions: 1
Overall Sentiment: AGENT=0.9, CUSTOMER=1
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/03/20/828fac0c-311d-4493-aba8-57bd3f7d6f9a_20250320T17:35_UTC.wav
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[AGENT][POSITIVE] Thanks for calling APL. This is [PII]. How may I assist you?
[CUSTOMER][NEUTRAL] Hi, my name is [PII]. I'm calling from Advanced Orthopedics of Oklahoma. I just need to verify patients eligibility benefits.
[AGENT][NEUTRAL] Sure, [PII], I could assist you with that. Can I have a callback number, the spelling of your name and the policy number?
[CUSTOMER][NEUTRAL] Yes, um, callback number is [PII].
[CUSTOMER][NEUTRAL] My name is [PII], it's [PII]
[AGENT][POSITIVE] Thank you.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] And the policy number?
[CUSTOMER][NEUTRAL] And policy number is 213855-557.
[AGENT][NEUTRAL] Could you verify this patient's name and date of birth?
[CUSTOMER][NEUTRAL] [PII] date of birth is [PII].
[AGENT][NEUTRAL] [PII], you're calling to verify benefits eligibility. This policy has been active since [PII] and it's currently active. Let me give you the correct policy number.
[CUSTOMER][NEUTRAL] Yes mhm.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] It is 256-653-5. That's 2566535.
[CUSTOMER][NEUTRAL] 6652566535.
[AGENT][NEUTRAL] 256-653-5, yes, and you're calling to verify outpatient benefits?
[CUSTOMER][NEUTRAL] OK
[CUSTOMER][NEUTRAL] It'll be for an in office um.
[CUSTOMER][POSITIVE] Benefits for specialist office visit and X-rays.
[AGENT][NEUTRAL] The office visits are not covered. However, the treatment received in the office will be covered under the outpatient benefits of $3000 per calendar year, and this is not a guaranteed benefits, just a disclaimer of the policy's coverage.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] Is there anything else that I can assist you with today?
[CUSTOMER][NEUTRAL] And has anything been met on that?
[CUSTOMER][NEUTRAL] Um, has anything been met on that 3000?
[AGENT][NEUTRAL] That's the benefit amount that he has, so you wanna know if anything's been used for that from that 3000?
[CUSTOMER][NEUTRAL] Yes, mhm.
[CUSTOMER][NEUTRAL] Yes.
[AGENT][NEUTRAL] He's utilized $345.44 of his benefits for $25.
[CUSTOMER][NEUTRAL] OK, and this patient does have Blue Cross and community care. Um, this APL would be their payer of Osor correct?
[AGENT][NEUTRAL] This is the gap insurance.
[AGENT][NEUTRAL] So we'll be the secondary.
[CUSTOMER][NEUTRAL] OK, so it'd be covered.
[CUSTOMER][NEUTRAL] But if the patient had Blue Cross and they had community care then it would be there.
[CUSTOMER][POSITIVE] Tertiary correct.
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] You would just pay last. OK, just wanna make sure because it was filed weird. OK, well that is all I was needing for today then. um, can I have a reference number for our call?
[AGENT][NEUTRAL] We don't provide those, [PII], however, you can use my name in today's date as a reference.
[CUSTOMER][POSITIVE] OK wonderful thank you so much for your help today.
[AGENT][POSITIVE] You're welcome. Thanks for calling APL. Have a great day.
[CUSTOMER][POSITIVE] You too thank you bye bye.