AccountId: 011433970860
ContactId: 8b1066c8-120a-4c67-b14b-79f81d5bc4cc
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 205460 ms
Total Talk Time (AGENT): 74068 ms
Total Talk Time (CUSTOMER): 68757 ms
Interruptions: 0
Overall Sentiment: AGENT=0.8, CUSTOMER=0.6
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/06/06/8b1066c8-120a-4c67-b14b-79f81d5bc4cc_20250606T22:07_UTC.wav
--------------------------------------------
[AGENT][NEUTRAL] Thank you for calling APL. This is [PII]. How can I help you?
[CUSTOMER][NEUTRAL] Hi [PII], good evening. My name is [PII]. The initial to my last name is [PII] calling from the provider's office of Ortho now. Um, a good callback number is [PII].
[CUSTOMER][NEUTRAL] And I was just calling on behalf of a
[AGENT][NEUTRAL] OK, and how can I help you?
[CUSTOMER][NEUTRAL] Yes, I was calling on a mutual member to verify the benefits of for the secondary policy insurance, um, just to see if you guys cover as far as the co-pay from the primary. I have the um policy number when you need it.
[AGENT][POSITIVE] OK, I'm ready.
[CUSTOMER][NEUTRAL] It's 971-058.
[AGENT][NEUTRAL] OK, give me just a moment.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] Can you verify the patient's name and date of birth for me please?
[CUSTOMER][NEUTRAL] Yes, it's gonna be for [PII] and the last name is um I'll spell it is [PII] His date of birth is [PII].
[AGENT][POSITIVE] OK, thank you so much.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] And so this is secondary gap insurance. Um, it helps cover co-pay, co-deductible and co-insurance. Were there specific benefits that you, uh, would like me to look out for you?
[CUSTOMER][NEUTRAL] Um, for like urgent care.
[AGENT][NEUTRAL] Urgent care, OK.
[CUSTOMER][NEUTRAL] Give me 1 2nd, I'm so sorry.
[AGENT][NEUTRAL] Yeah OK.
[CUSTOMER][POSITIVE] OK, I'm back sorry about that.
[AGENT][NEUTRAL] That's OK. Um, so this is an explanation of benefits, not a guarantee of payment. It looks like [PII] has a.
[AGENT][NEUTRAL] In hospital benefit maximum of up to $5500 per calendar year with a 0 $0 deductible, uh, outpatient benefits are up to $4250 per calendar day.
[AGENT][NEUTRAL] And it looks like he does have urgent care.
[AGENT][NEUTRAL] Um,
[AGENT][NEUTRAL] Benefits with a maximum of 3 urgent care visits per covered person.
[AGENT][NEUTRAL] Per calendar year.
[CUSTOMER][NEUTRAL] Got it.
[CUSTOMER][NEUTRAL] OK, and the out of pocket you said was 4250?
[AGENT][NEUTRAL] Uh, that's how much we will pay up to 4250.
[CUSTOMER][NEUTRAL] Oh, got you.
[CUSTOMER][NEUTRAL] OK, got you. Alrighty. And what is the initial to your last name?
[AGENT][NEUTRAL] [PII].
[CUSTOMER][NEUTRAL] OK, and then the reference number is your name and today's date?
[AGENT][NEUTRAL] My name and last initial on today's date, yes ma'am.
[CUSTOMER][POSITIVE] Thank you so much have a good one.
[AGENT][POSITIVE] Thank you for calling APL. Have a great weekend.