AccountId: 011433970860
ContactId: 94ba0066-d580-4443-b906-82ce90e208a3
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 191899 ms
Total Talk Time (AGENT): 94278 ms
Total Talk Time (CUSTOMER): 74378 ms
Interruptions: 0
Overall Sentiment: AGENT=0.4, CUSTOMER=0.9
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/02/14/94ba0066-d580-4443-b906-82ce90e208a3_20250214T15:39_UTC.wav
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[AGENT][NEUTRAL] Thank you for calling APL. This is [PII]. How may I help you?
[CUSTOMER][NEUTRAL] Hi, my name is [PII]. I'm calling from South Florida A&T. I was calling to verify a member's benefits with um this plan. Mhm.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] OK, so is this a specialist office?
[CUSTOMER][NEUTRAL] Yes.
[AGENT][NEUTRAL] OK, what's the policy number?
[CUSTOMER][NEUTRAL] It would be 02295897 ML 8.
[AGENT][NEUTRAL] And what's a good phone number in case we're disconnected?
[CUSTOMER][NEUTRAL] It's [PII].
[AGENT][POSITIVE] Thank you.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] And the patient's name and date of birth?
[CUSTOMER][NEUTRAL] It's [PII]. Date of birth is [PII].
[AGENT][NEUTRAL] OK, thank you for that. So I have the information for you. The policy effective date is [PII]. This policy is active at this time.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] And let me check the.
[AGENT][NEUTRAL] Let's see, so the
[CUSTOMER][NEUTRAL] It
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] So the physician's visit fee is not covered. Um, there is a treatment writer, so covered treatment can be considered under the outpatient benefit.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] I was it's more for a surgery that she's having with our specialist.
[AGENT][NEUTRAL] In office or outpatient facility?
[CUSTOMER][NEUTRAL] Um
[CUSTOMER][NEUTRAL] No
[CUSTOMER][NEUTRAL] It's at an outpatient facility. It's an ambulatory surgical center.
[AGENT][NEUTRAL] Oh, OK. Did you need that benefit?
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][POSITIVE] Yes please.
[AGENT][NEUTRAL] OK, so the maximum outpatient benefit per calendar year is $3500.
[AGENT][NEUTRAL] And this information of course is verification. It doesn't uh there uh guarantee payment of a claim until we get the actual claim documents and I'll check to see if any of that has been used for [PII].
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK. You.
[AGENT][NEUTRAL] I don't show any claims received for [PII] at this time, so that amount is available at this time.
[CUSTOMER][NEUTRAL] You said 3000. I'm sorry, what was the, the amount?
[AGENT][NEUTRAL] 3500, 3500.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] Her calendar year.
[CUSTOMER][POSITIVE] Got it alright perfect.
[CUSTOMER][NEUTRAL] Um, and that includes, um, the surgeon fees and things like that?
[AGENT][NEUTRAL] Facility, anesthesiologist, and any ancillary charges. That's the maximum.
[CUSTOMER][NEUTRAL] Oh, OK, perfect. All right, then if I may just have a, a reference number for this call, please.
[AGENT][NEUTRAL] Mhm.
[AGENT][NEUTRAL] Sure, you'll use my name in today's date, [PII]
[CUSTOMER][NEUTRAL] [PII]
[AGENT][NEUTRAL] Mhm. [PII].
[CUSTOMER][NEUTRAL] And
[AGENT][NEUTRAL] And you'll use my name in today's date as reference for today's call.
[CUSTOMER][POSITIVE] Got it perfect thank you so much for your help, really appreciate it.
[AGENT][POSITIVE] Uh, you're welcome, [PII] and if no other questions, thanks for calling APL. Have a good day.
[CUSTOMER][POSITIVE] You too bye thank you.
[AGENT][NEUTRAL] Bye bye.