AccountId: 011433970860
ContactId: 86e9ebc5-d75b-4e36-a99e-3aae392843e4
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 269130 ms
Total Talk Time (AGENT): 116379 ms
Total Talk Time (CUSTOMER): 100387 ms
Interruptions: 0
Overall Sentiment: AGENT=1.6, CUSTOMER=0.9
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/05/07/86e9ebc5-d75b-4e36-a99e-3aae392843e4_20250507T17:11_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] Hi [PII], this is [PII] from Tyson I calling. I was calling to check benefits on a member.
[AGENT][POSITIVE] OK, well, I can definitely help you with the benefits and [PII], may I have a good contact number in case we're disconnected?
[CUSTOMER][NEUTRAL] It's [PII].
[CUSTOMER][NEUTRAL] [PII]
[AGENT][NEUTRAL] Thank you for that. And may I have the member's policy number?
[CUSTOMER][NEUTRAL] I have that would be like an outpatient benefit certificate number would that be correct?
[AGENT][POSITIVE] Yes, that's correct.
[CUSTOMER][NEUTRAL] OK. 02263078 M as in Mary, L as in Larry, 8.
[AGENT][NEUTRAL] Thank you for that. And can you verify the member's first and last name and date of birth?
[CUSTOMER][NEUTRAL] I have [PII], date of birth [PII].
[AGENT][NEUTRAL] Thank you for that and all the information provided is a verification of benefits, not a guarantee of payment. So I'm actually showing this particular policy is no longer active. Um, it was effective from [PII], but there is an active policy. Let me get that for you. Hold on one moment.
[CUSTOMER][POSITIVE] OK, thank you.
[AGENT][POSITIVE] You're welcome.
[AGENT][NEUTRAL] OK, so the Axis policy number is 254.
[AGENT][NEUTRAL] 9550.
[AGENT][NEUTRAL] And it's been active since [PII].
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] And what type of benefits did you want to go over today?
[CUSTOMER][NEUTRAL] Let me look here we're looking for specialist office visit.
[AGENT][NEUTRAL] Alright, so under outpatient, the policy will pay up to $750 per calendar day. This does include
[AGENT][NEUTRAL] Hold on.
[AGENT][NEUTRAL] The treatment, let me, yeah, treatment in a physician's office, um, which for us is the specialist as well, um, so it's up to that 750 per day.
[CUSTOMER][NEUTRAL] Is there a limitation on how many?
[CUSTOMER][NEUTRAL] Days, how many visits?
[AGENT][NEUTRAL] No, not for this policy. So they just have the per day max. So whatever claims come in for that day, we'll just pay them up to that $750.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] OK, and then if they were seen like say the next week the 7:50 would start again?
[AGENT][NEUTRAL] It's every day, it's per day. So it's $750 each day. Mhm.
[CUSTOMER][NEUTRAL] It's per day. OK.
[CUSTOMER][NEUTRAL] Each day, OK. Treatment in the specialist office. Um, now, that includes like, should they have surgery, does that fall under, like outpatient surgery, that falls under this benefit also?
[AGENT][NEUTRAL] Yes, ma'am.
[AGENT][NEUTRAL] Right, outpatient can be um surgeries.
[CUSTOMER][NEUTRAL] Because it's outpatient benefit office, surgery, whichever.
[AGENT][NEUTRAL] Right. Emergency room, urgent care.
[AGENT][NEUTRAL] It's just, that's how her policy is broken down inpatient and outpatient, so unless it's admission to the hospital is outpatient.
[CUSTOMER][NEUTRAL] OK
[CUSTOMER][NEUTRAL] Alright, got it. Alright, perfect. And it's [PII]. I'm just looking here at her old card and the claims still go to American Public [PII] at [PII]. OK, perfect. All right, perfect. Just want to make sure that was still correct. All right, perfect. Thank you so much. Is there a reference number for the call?
[AGENT][NEUTRAL] Mhm.
[AGENT][NEUTRAL] Yes, [PII].
[AGENT][POSITIVE] Yes, that's correct.
[AGENT][NEUTRAL] So there's no call reference number, but you can use my name in today's date, and again, that's [PII], first initial and my last name is [PII].
[CUSTOMER][POSITIVE] All right, thank you and I appreciate your help.
[AGENT][POSITIVE] You're welcome, [PII]. Well, thanks for calling [PII]. I hope you have a great week.
[CUSTOMER][POSITIVE] Thanks you too.
[AGENT][POSITIVE] Thank you. Bye bye.
[CUSTOMER][NEUTRAL] Bye bye.