AccountId: 011433970860
ContactId: 94e374a3-a9f8-425f-8c17-f42aebe45d90
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 191679 ms
Total Talk Time (AGENT): 97083 ms
Total Talk Time (CUSTOMER): 78040 ms
Interruptions: 2
Overall Sentiment: AGENT=1.1, CUSTOMER=0.7
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/01/27/94e374a3-a9f8-425f-8c17-f42aebe45d90_20250127T19:18_UTC.wav
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[CUSTOMER][NEUTRAL] And
[AGENT][POSITIVE] Good afternoon. Thank you for calling APL. My name is [PII]. How may I help you?
[CUSTOMER][NEUTRAL] Hi [PII], my name is [PII]. I'm calling from the orthopedic center. I need benefits um for a patient, eligibility rather.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] Well, I can help you with the eligibility and benefits, and [PII], may I have a good contact number in case we're disconnected and the policy number?
[CUSTOMER][NEUTRAL] [PII] and the ID number is 0247711726401.
[AGENT][NEUTRAL] Wait, is that their APL policy number or their major insurance?
[CUSTOMER][NEUTRAL] Mhm
[CUSTOMER][NEUTRAL] Oh shoot, I gave you too many numbers. I'm sorry. It's
[CUSTOMER][NEUTRAL] Is I gave you the, the um ID number and group number together. I'm sorry. It's 024771117.
[AGENT][NEUTRAL] That's OK.
[AGENT][NEUTRAL] OK, hold on one second.
[CUSTOMER][POSITIVE] OK. And I'm sorry about the noise. They're cutting trees.
[AGENT][NEUTRAL] Oh, you're, you're fine. And can you verify the member's first and last name and date of birth?
[CUSTOMER][NEUTRAL] Yes, [PII]. Date of birth is [PII].
[AGENT][NEUTRAL] Thank you for that and all the information provided is a verification of benefits, not a guarantee of payment. So I am showing that the policy is active. It's been effective since [PII].
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] And what type of benefits did you want to go over today?
[CUSTOMER][NEUTRAL] Um, so this is her secondary to her Medicare, so they just, I'm sorry, uh, secondary to admin, so they basically cover whatever admin doesn't.
[AGENT][NEUTRAL] Well, no, so our policy has its own coverage as well or benefits that we cover, but we pay towards the copay, deductible and co-insurance of coverage charges after their primary. Um, there's a calendar year max, um, well, are you all considered outpatient, I'm assuming?
[CUSTOMER][NEUTRAL] OK
[CUSTOMER][NEUTRAL] Yes, she is a, um, she came in for a specialist office visit.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] OK, so for outpatient, um, the policy could pay up to $7000 per calendar year, um, for, you said it was a specialist office visit?
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Yes.
[AGENT][NEUTRAL] Let me see, hold on one moment.
[AGENT][NEUTRAL] OK, so that does include, um, I was just making sure specialist office, but the um treatment in a physician's office, that includes the specialist as well. So it will be up to that $7000 per calendar year.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK, perfect. That's what I needed to know. um, is there a reference number for the call?
[AGENT][NEUTRAL] So there's no call reference number, but you can use my name in today's date again, that's [PII], first initial to my last name is [PII].
[CUSTOMER][POSITIVE] Thank you so much for your help, [PII].
[AGENT][POSITIVE] You also, oh, you're welcome, [PII], and thanks for calling ACL. I hope you have a good day.
[CUSTOMER][NEUTRAL] Mhm
[CUSTOMER][POSITIVE] Thank you, you too.
[AGENT][POSITIVE] Thank you. Bye bye.
[CUSTOMER][NEUTRAL] OK.