AccountId: 011433970860
ContactId: 8e25504f-ada3-4a47-817c-51d8a95eaa58
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 208910 ms
Total Talk Time (AGENT): 91115 ms
Total Talk Time (CUSTOMER): 119368 ms
Interruptions: 4
Overall Sentiment: AGENT=0.5, CUSTOMER=1
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/01/15/8e25504f-ada3-4a47-817c-51d8a95eaa58_20250115T16:38_UTC.wav
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[AGENT][NEUTRAL] Calling APL, this is [PII]. How may I help you?
[CUSTOMER][NEUTRAL] Hi, good morning. I'm sorry, what was your name again? I'm sorry.
[AGENT][NEUTRAL] [PII].
[CUSTOMER][NEUTRAL] [PII], hi [PII]. My name is [PII], and I'm calling from the Center of gynecology from Doctor [PII]'s office, and we're calling uh to check benefits for our patient, please.
[AGENT][NEUTRAL] Hi.
[AGENT][NEUTRAL] OK, and so you did say the service is in a specialist office?
[CUSTOMER][NEUTRAL] [PII]
[CUSTOMER][NEUTRAL] No, the services will be done in the center.
[AGENT][NEUTRAL] OK, outpatient facility.
[CUSTOMER][POSITIVE] But I'm calling from the yes yes correct.
[AGENT][NEUTRAL] OK, and what's the policy number?
[CUSTOMER][NEUTRAL] 02578984 MLH
[AGENT][POSITIVE] And a good phone number in case we're disconnected?
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] Thank you. And what's the patient's name and date of birth?
[CUSTOMER][POSITIVE] You're welcome.
[CUSTOMER][NEUTRAL] Patient's name is [PII]. Date of birth is [PII].
[AGENT][NEUTRAL] Thank you for that information, [PII]. So we'll provide the effective date and then the outpatient benefit for you today, showing the policy effective date is [PII], currently active at this time, and the maximum outpatient benefit is up to $1000. That is per calendar year.
[CUSTOMER][POSITIVE] You're welcome.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Yeah yeah
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] Information provided is verification. It doesn't guarantee payment of a claim, and none of that benefit has been used at this time.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Patient.
[CUSTOMER][NEUTRAL] OK, patient you said patient what amount.
[CUSTOMER][NEUTRAL] What did you say the first
[AGENT][NEUTRAL] The maximum outpatient benefit is up to.
[CUSTOMER][NEUTRAL] Patient maximum.
[AGENT][NEUTRAL] $1000 per calendar year.
[CUSTOMER][NEUTRAL] patient maximum outpatient you said outpatient?
[AGENT][NEUTRAL] Yeah you said this is for outpatient facility?
[CUSTOMER][NEUTRAL] Patient outpatient is up to 1000.
[AGENT][NEUTRAL] $1000.
[CUSTOMER][NEUTRAL] You said?
[CUSTOMER][NEUTRAL] Mhm per calendar year.
[AGENT][NEUTRAL] Per calendar year.
[CUSTOMER][NEUTRAL] OK, so this patient is having a procedure done.
[CUSTOMER][NEUTRAL] Um, her procedure is around 2,169. 71 cents.
[CUSTOMER][NEUTRAL] Um, would she be covered?
[AGENT][NEUTRAL] OK, so that's the benefit that she has under this policy. She, this policy is secondary to her major medical plan.
[CUSTOMER][NEUTRAL] The first one
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] OK, and it covers?
[AGENT][NEUTRAL] OK, we're not the major medical, so yeah, so this policy, uh, will pick up the deductible, co-insurance and or co-pay amount of cover charges up to $1000 per calendar year.
[CUSTOMER][NEUTRAL] And it covers whatever the unsure.
[CUSTOMER][NEUTRAL] OK, um, OK, [PII], I'm sorry, yeah, tomorrow there is no.
[CUSTOMER][NEUTRAL] Up to $1000 per calendar year, OK.
[AGENT][NEUTRAL] Right.
[CUSTOMER][NEUTRAL] And patient will be responsible for the rest.
[AGENT][NEUTRAL] We do not determine patients responsibility.
[CUSTOMER][NEUTRAL] I'm still
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Alright.
[CUSTOMER][NEUTRAL] Um, OK.
[CUSTOMER][NEUTRAL] Let me see, OK.
[CUSTOMER][NEUTRAL] And we are network.
[CUSTOMER][NEUTRAL] Mm. No authorization right.
[AGENT][NEUTRAL] No authorization is required.
[CUSTOMER][POSITIVE] OK, perfect.
[CUSTOMER][POSITIVE] Um, OK, [PII], thank you so much for your help, OK?
[AGENT][NEUTRAL] Alrighty, and you use my name and today's date as reference for today's call.
[CUSTOMER][POSITIVE] OK, thank you so much.
[AGENT][POSITIVE] Alrighty, and thank you for calling APL [PII]. If no other questions, have a good day.
[CUSTOMER][NEUTRAL] You too.