AccountId: 011433970860
ContactId: 8ae27bb8-05d6-4249-ae94-a6a6608c4e87
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 250080 ms
Total Talk Time (AGENT): 91419 ms
Total Talk Time (CUSTOMER): 111468 ms
Interruptions: 4
Overall Sentiment: AGENT=0, CUSTOMER=0.8
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/02/11/8ae27bb8-05d6-4249-ae94-a6a6608c4e87_20250211T15:18_UTC.wav
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[AGENT][NEUTRAL] Thank you for calling APL. This is [PII]. How may I help you?
[CUSTOMER][POSITIVE] Thanks for calling APL
[CUSTOMER][NEUTRAL] Hello, good morning. This is [PII]. I'm calling regarding a mutual member. I'm just trying to check the eligibility and benefits for it.
[AGENT][NEUTRAL] OK, is this for service in an office, [PII]?
[CUSTOMER][NEUTRAL] Service
[CUSTOMER][NEUTRAL] Yes.
[AGENT][NEUTRAL] OK, and what's the policy number?
[CUSTOMER][NEUTRAL] Uh, that would be 022035 I'm I'm sorry, 3733 ML 8.
[AGENT][NEUTRAL] OK, 022 03733?
[CUSTOMER][NEUTRAL] Yes.
[AGENT][NEUTRAL] OK, and what's a good phone number in case we're disconnected?
[CUSTOMER][NEUTRAL] The phone number
[CUSTOMER][NEUTRAL] [PII].
[AGENT][POSITIVE] Thank you.
[AGENT][NEUTRAL] And the patient's name and date of birth?
[CUSTOMER][NEUTRAL] And
[CUSTOMER][NEUTRAL] That'll be [PII]. Date of birth [PII].
[AGENT][NEUTRAL] Thank you for that information, and you're just wanting to verify eligibility and then office visit benefit?
[CUSTOMER][NEUTRAL] eligibility and then.
[CUSTOMER][NEUTRAL] Yes, I just wanna double check if it covers anything for the office visits.
[AGENT][NEUTRAL] OK, let me give you the current policy number, it's 251.
[CUSTOMER][NEUTRAL] The current policy number.
[CUSTOMER][NEUTRAL] OK
[AGENT][NEUTRAL] 293 2.
[CUSTOMER][NEUTRAL] 29
[AGENT][NEUTRAL] Uh, Effective date is [PII]. Policy is active at this time.
[CUSTOMER][NEUTRAL] The date is June.
[AGENT][NEUTRAL] One moment.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] Alright, so the physician fee is not covered, but this policy does have.
[CUSTOMER][NEUTRAL] Like
[CUSTOMER][NEGATIVE] The physician fee is not covered.
[AGENT][NEUTRAL] A treatment writer, so if there's covered treatment, uh, during the office visit, uh, those items can be considered.
[CUSTOMER][NEUTRAL] Treatment during the visit.
[CUSTOMER][MIXED] OK, but for a regular visit, it does not cover the primary um copays, correct?
[AGENT][POSITIVE] Yeah, that is correct.
[CUSTOMER][NEUTRAL] OK perfect sounds good. I also have another member. I'm not sure if you're able to help me with that one as well.
[AGENT][NEUTRAL] You said you have another patient?
[CUSTOMER][NEUTRAL] Yes.
[AGENT][NEUTRAL] OK, give me one moment.
[CUSTOMER][POSITIVE] Sure thing thank you.
[AGENT][NEUTRAL] And what is the policy number?
[CUSTOMER][NEUTRAL] M 02255705.
[AGENT][NEUTRAL] And the patient's name and date of birth?
[CUSTOMER][NEUTRAL] Well, the patient that I have in my office would be [PII] [PII], but I do see that the name on the insurance card is [PII].
[AGENT][NEUTRAL] Mhm. So [PII] is the patient?
[CUSTOMER][NEUTRAL] Yes.
[AGENT][NEUTRAL] OK. So her policy effective date is [PII].
[CUSTOMER][NEUTRAL] OK
[AGENT][NEUTRAL] Policy is active at this time and this is for an office visit as well.
[CUSTOMER][POSITIVE] Yes, correct.
[AGENT][NEUTRAL] All right, under this policy, the physician visit copay is not covered.
[CUSTOMER][NEUTRAL] Physician
[CUSTOMER][NEUTRAL] OK perfect so it'll be just the same as the other one it covers like procedures and stuff like that but no regular office visits.
[AGENT][NEGATIVE] Uh, incorrect. This one does not cover procedures in the office. It's a different policy.
[CUSTOMER][POSITIVE] Oh, that it, it doesn't? OK, perfect.
[AGENT][NEGATIVE] This policy does not.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][POSITIVE] Perfect. Can I obtain a reference number for this call?
[AGENT][NEUTRAL] Mhm you'll use my name and today's date as your reference. [PII].
[AGENT][NEUTRAL] Oh NYA first initial last name is [PII], and did you have any other questions we can help out with today?
[CUSTOMER][POSITIVE] No, that should be it, thank you.
[AGENT][POSITIVE] You're welcome thank you for calling APL have a good day.
[CUSTOMER][NEUTRAL] You too bye bye.
[AGENT][NEUTRAL] Bye bye.