AccountId: 011433970860
ContactId: 8b827b1f-192c-424f-90e7-27ea249d967f
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 618510 ms
Total Talk Time (AGENT): 156661 ms
Total Talk Time (CUSTOMER): 156133 ms
Interruptions: 0
Overall Sentiment: AGENT=0.1, CUSTOMER=0.5
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/01/13/8b827b1f-192c-424f-90e7-27ea249d967f_20250113T18:35_UTC.wav
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[AGENT][NEUTRAL] Thank you for calling APL. This is [PII]. How may I help you?
[CUSTOMER][NEUTRAL] Hi, [PII], this is [PII] calling from Reubin Associates to verify the eligibility and benefits of a patient. How are you doing today?
[AGENT][NEUTRAL] OK, hi [PII], I can help you with eligibility and benefits, sir. Can I please get your callback number?
[CUSTOMER][NEUTRAL] Yeah, the callback number will be [PII].
[AGENT][NEUTRAL] Thank you, sir. And then what is the patient's name?
[CUSTOMER][NEUTRAL] First name will be [PII] and the last name will be [PII], and the date of birth will be [PII].
[AGENT][NEUTRAL] OK. And then what is [PII]'s policy number?
[CUSTOMER][NEUTRAL] It will be 228-804-1.
[AGENT][NEUTRAL] OK, let me look that up real quick.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] OK, I do show that [PII] does have.
[AGENT][NEUTRAL] An active policy. His effective date is [PII].
[CUSTOMER][NEUTRAL] They
[AGENT][NEUTRAL] And if you give me your fax number I can send you a fax back with this complete breakdown of this benefits along with procedure codes and any limitations.
[CUSTOMER][NEUTRAL] Yeah, can you please help me through call? It will take nearly 2 to 3 minutes.
[AGENT][NEUTRAL] OK, certainly.
[CUSTOMER][POSITIVE] Yeah, thanks for that. Mhm.
[CUSTOMER][NEUTRAL] It
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] What is your next question?
[CUSTOMER][NEUTRAL] Yeah, what would be the individual and family deductibles and annual max dollar amount?
[AGENT][NEUTRAL] OK, let me look that up for you real quick.
[CUSTOMER][NEUTRAL] Mhm
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] OK
[AGENT][NEUTRAL] OK, this is just to confirm benefits it's not a guarantee of payment. He has uh.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] Calendar year benefit amount of $1500 per covered insured.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] He has a deductible of $50 per covered insured up to $150 for the family.
[CUSTOMER][NEUTRAL] You don't have to get
[CUSTOMER][NEUTRAL] Yeah, OK. And what will be the preventative basic and major coincidence percentages?
[AGENT][NEUTRAL] It's UCR.
[CUSTOMER][NEUTRAL] Sorry?
[AGENT][NEUTRAL] The preventative is 100% of UCR.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] And then what was the 2nd?
[CUSTOMER][NEUTRAL] Yeah, yeah, just one more thing.
[AGENT][NEUTRAL] Did you
[CUSTOMER][POSITIVE] Yeah, you're helping me in network benefits, right?
[AGENT][NEUTRAL] Mhm.
[AGENT][NEUTRAL] I'm sorry, what did you just say, sir? Can you repeat that?
[CUSTOMER][POSITIVE] Yeah, you are helping me with in-network, right?
[AGENT][POSITIVE] I'm helping you, yes, I am helping you.
[CUSTOMER][NEUTRAL] Yeah, with in network bandwidth right?
[CUSTOMER][NEUTRAL] Hello.
[AGENT][NEUTRAL] I'm sorry, I don't understand. I'm sorry, I don't understand the question.
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] The provider is in network or out of network?
[AGENT][NEUTRAL] Oh, there's not a network they can go anywhere they want to.
[CUSTOMER][NEUTRAL] Yeah, OK, and what will be the group name and group number?
[AGENT][NEUTRAL] The group name is Universal Trucking.
[AGENT][NEUTRAL] American Midwest.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] And the the um group number is 15586.
[CUSTOMER][NEUTRAL] 15586. Yeah, OK, just a second.
[CUSTOMER][NEUTRAL] And this is a calendar plan, right?
[AGENT][NEUTRAL] And what is
[AGENT][NEUTRAL] I'm sorry, what was the question again?
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] It is a calendar plan, right?
[AGENT][NEUTRAL] Yes.
[CUSTOMER][NEUTRAL] Orviscal plan.
[CUSTOMER][NEUTRAL] OK. And from the deductibles, anything has been met?
[AGENT][NEUTRAL] Let me look and see.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Yeah
[CUSTOMER][NEUTRAL] You
[AGENT][NEGATIVE] No, nothing has been met.
[CUSTOMER][NEUTRAL] OK. And from the annual max, anything has been used?
[AGENT][NEGATIVE] Nothing has been used.
[CUSTOMER][NEUTRAL] OK. And what will be the coincidence for?
[CUSTOMER][NEUTRAL] 0220 and frequency?
[CUSTOMER][NEUTRAL] 21
[CUSTOMER][NEUTRAL] To
[AGENT][NEUTRAL] OK, the call reference is my name, [PII] and today's date.
[CUSTOMER][NEUTRAL] Yeah, [PII], can you check if there is any history with effective frequency?
[CUSTOMER][NEUTRAL] want to
[AGENT][NEUTRAL] OK, let me see his history.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] And what was the procedure for the history, the procedure number?
[CUSTOMER][NEUTRAL] Yeah, for preventive, yeah, for preventative.
[AGENT][NEUTRAL] What was the procedure number?
[CUSTOMER][NEUTRAL] I need history.
[CUSTOMER][NEUTRAL] It will be 0120.
[AGENT][NEUTRAL] That is 0120?
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] [PII].
[CUSTOMER][NEUTRAL] Finish
[CUSTOMER][NEUTRAL] So.
[CUSTOMER][NEUTRAL] She has I
[CUSTOMER][NEUTRAL] Football Sunday.
[AGENT][NEUTRAL] OK, the last time that procedure was used was on [PII].
[CUSTOMER][NEUTRAL] OK
[CUSTOMER][NEUTRAL] And for 0210?
[CUSTOMER][NEUTRAL] The pick up, you have 2 tickets, same day.
[AGENT][NEUTRAL] OK, let me check.
[CUSTOMER][NEUTRAL] What?
[CUSTOMER][NEUTRAL] Mhm
[CUSTOMER][NEUTRAL] Oh.
[AGENT][NEUTRAL] And that was 0210?
[CUSTOMER][NEUTRAL] Well
[CUSTOMER][NEUTRAL] Mhm FMX.
[CUSTOMER][NEUTRAL] Delta rental.
[AGENT][NEUTRAL] I'm not showing that has been used.
[CUSTOMER][NEUTRAL] Just now you have 3
[CUSTOMER][POSITIVE] Yeah, OK. Thanks for that. And for 110?
[AGENT][NEUTRAL] The last time I showed that procedure was used on.
[AGENT][NEUTRAL] Hm.
[AGENT][NEUTRAL] [PII].
[CUSTOMER][NEUTRAL] [PII].
[CUSTOMER][NEUTRAL] And the last 1, 0274?
[CUSTOMER][NEUTRAL] White wings.
[AGENT][NEUTRAL] 0224, you said, sir?
[CUSTOMER][NEUTRAL] It will be 0274.
[CUSTOMER][NEUTRAL] They
[AGENT][NEUTRAL] That one was used on.
[AGENT][NEUTRAL] [PII].
[CUSTOMER][POSITIVE] Yeah, thank you, [PII]. Thank you for your assistance. And the call reference number will be today's date and your name, right?
[AGENT][POSITIVE] Yes, that's correct.
[CUSTOMER][POSITIVE] Yeah, thank you, [PII]. Thank you for your assistance. I'm done with my patient. Bye. Have a nice day.
[AGENT][POSITIVE] You have a great day too, [PII]. Thank you for calling APL.
[CUSTOMER][NEUTRAL] Yeah bye.