AccountId: 011433970860
ContactId: 93ec9129-c85c-4626-91f1-483a11d494d9
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 243589 ms
Total Talk Time (AGENT): 112111 ms
Total Talk Time (CUSTOMER): 127458 ms
Interruptions: 4
Overall Sentiment: AGENT=1.3, CUSTOMER=0.8
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/06/02/93ec9129-c85c-4626-91f1-483a11d494d9_20250602T16:31_UTC.wav
--------------------------------------------
[AGENT][NEUTRAL] Good morning. Thank you for calling APL. This is [PII]. How may I assist you?
[CUSTOMER][NEUTRAL] Hi, yes, good afternoon, so my name is [PII] from Doctor [PII]'s office, the gastroenterologist. Um, I wanted to, um, verify eligibility and benefits on a patient who's here, please.
[AGENT][NEUTRAL] OK, sure. I can assist you with the eligibility and benefits, and I'm sorry, I didn't quite catch your name. Can you repeat your name?
[CUSTOMER][NEUTRAL] Yes, it's [PII].
[AGENT][NEUTRAL] [PII]. OK. Thank you, Miss [PII]. And may I have a callback number just in case we get disconnected?
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Yeah, [PII].
[AGENT][NEUTRAL] OK, thank you. And may I have the patient's policy number?
[CUSTOMER][NEUTRAL] Uh, policy number I have here.
[CUSTOMER][NEUTRAL] 023 041777. M as in Mary, L as in Larry 8.
[AGENT][POSITIVE] Perfect. Thank you. May I have the name and date of birth of the patient?
[CUSTOMER][NEUTRAL] Yes, Mr. [PII] and [PII].
[AGENT][POSITIVE] Perfect, thank you. And you said you need eligibility and benefits, and this is gonna be for a specialist office, Miss [PII]?
[CUSTOMER][NEUTRAL] Mhm
[CUSTOMER][NEUTRAL] Uh, yes, for a specialist office visit. Thank you. Um, he has, I'm so sorry, just to let you know, he has here United Healthcare as his, um, primary.
[AGENT][NEUTRAL] OK. All right, let's see.
[AGENT][NEUTRAL] Um, let's
[CUSTOMER][NEUTRAL] Um, so I just wanna see if you guys cover anything.
[AGENT][NEUTRAL] OK. All right. Sure. Let me check his benefits and this is not a guarantee of payment, just a verification of coverage and that's just a disclaimer. And let's see. We have an effective date of
[CUSTOMER][NEUTRAL] From them.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] [PII]. It is active at the moment and this is one of our secondary supplemental plans to the major medical. Now with this one, we do not cover office. So service rendered in office is not covered.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Oh.
[CUSTOMER][NEUTRAL] Uh, so office visits for specialists not covered.
[AGENT][NEGATIVE] No, office visits or office procedures are not covered under this one.
[CUSTOMER][NEUTRAL] Oh
[CUSTOMER][NEGATIVE] And then it doesn't cover no.
[CUSTOMER][NEUTRAL] Office procedures.
[AGENT][NEUTRAL] Mm, no.
[CUSTOMER][NEUTRAL] No.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] This is uh so let's say if it's done at a hospital with any you guys cover anything over there.
[AGENT][NEUTRAL] Yes, if it's done in an outpatient freestanding outpatient facility or in um hospital, then it's gonna be subject to the outpatient maximum which is 2000 per covered person per calendar year and again this is not a guarantee of payment, just a verification of coverage.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] 2000 so either hospital or outpatient.
[AGENT][NEUTRAL] Facility, no office.
[CUSTOMER][NEUTRAL] So that would, that would cover, so and you guys would cover up to 2000.
[AGENT][NEUTRAL] Mhm
[AGENT][POSITIVE] Correct.
[CUSTOMER][NEUTRAL] Per year calendar year.
[AGENT][NEUTRAL] Per year per calendar year.
[CUSTOMER][NEUTRAL] I see nothing bad, no.
[CUSTOMER][POSITIVE] OK, alright, I think that's all I needed to know. Awesome. And is there a reference number for this call so?
[AGENT][NEUTRAL] Mm
[AGENT][NEUTRAL] We don't have reference numbers. You can use my name in today's date if you will. Do you need the spelling of my name or any other information?
[CUSTOMER][POSITIVE] No, no, that's all thank you so much for your help. I really appreciate it.
[AGENT][NEUTRAL] Mm.
[AGENT][POSITIVE] You're welcome, Ms. [PII]. Thank you for calling APO. Have a good day.
[CUSTOMER][POSITIVE] You too hon thank you bye bye.
[AGENT][POSITIVE] Thank you. Bye-bye.