AccountId: 011433970860
ContactId: 96072fb6-b606-4f3e-902c-ce3ba52bbd36
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 216479 ms
Total Talk Time (AGENT): 111783 ms
Total Talk Time (CUSTOMER): 62114 ms
Interruptions: 0
Overall Sentiment: AGENT=0.5, CUSTOMER=0.3
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/01/06/96072fb6-b606-4f3e-902c-ce3ba52bbd36_20250106T20:11_UTC.wav
--------------------------------------------
[AGENT][NEUTRAL] Good afternoon. Thank you for calling APL. This is [PII]. How may I assist you?
[CUSTOMER][NEUTRAL] Hi, good afternoon. I'm calling from a specialist office regarding a mutual patient. I need benefit information.
[AGENT][NEUTRAL] Mhm
[AGENT][POSITIVE] OK, yeah, sure, I can assist you with benefits. And may I have your name?
[CUSTOMER][NEUTRAL] My name is [PII].
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] Ms. [PII], may I have a callback number just in case we get disconnected?
[CUSTOMER][NEUTRAL] Yes, [PII].
[AGENT][NEUTRAL] Thank you and may I have the patient's policy number?
[CUSTOMER][NEUTRAL] Uh, policy number is 987658.
[AGENT][POSITIVE] OK, thank you.
[AGENT][NEUTRAL] What's the name and date of birth of the patient?
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] What's the date of birth?
[CUSTOMER][NEUTRAL] Date of birth is [PII].
[AGENT][NEUTRAL] Thank you. All right, let me see if I have a new policy.
[CUSTOMER][NEUTRAL] Yeah
[AGENT][NEUTRAL] Bear with me.
[AGENT][NEUTRAL] OK, I did find a new policy. Let me know when you're ready for the policy number.
[CUSTOMER][NEUTRAL] Oh, she has a new policy number.
[AGENT][NEUTRAL] Yes.
[CUSTOMER][POSITIVE] OK, I'm ready.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] The new policy number is 01.
[AGENT][NEUTRAL] 54
[AGENT][NEUTRAL] 859 7.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] OK, and what type of services can you render for benefits?
[CUSTOMER][NEUTRAL] Um, well, we do, we're a gastroenterologist's office, so I'm just looking to see her effective date if she requires a referral, co-pay, deductible, and that's about it.
[AGENT][NEUTRAL] Oh, OK. Well, Miss [PII], this particular policy is a secondary supplemental plan to the major medical. It's not the major medical, this is a secondary, um.
[CUSTOMER][NEUTRAL] Yeah
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] So with this one.
[AGENT][NEUTRAL] Let's see, um.
[AGENT][NEUTRAL] OK, we cover office treatment and office procedures, but we do not cover the office visit. Um, the office procedure is subject to the outpatient maximum which is 5000 per cover person per calendar year, and this is not a guarantee of payment, just a verification of coverage and that's just a disclaimer.
[AGENT][NEUTRAL] The policy is active. It was effective [PII].
[CUSTOMER][NEUTRAL] Yeah
[CUSTOMER][NEUTRAL] OK, so do you guys cover a co-payment if she has one with her primary?
[AGENT][NEUTRAL] If it's for a procedure, not the office visit, we will, but if it's the office visit, we do not cover the co-payment for the office visit. We only cover for procedures or treatment. OK?
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Can I have your name please?
[AGENT][NEUTRAL] My name is [PII]. That's [PII].
[CUSTOMER][NEUTRAL] OK, and a reference number please?
[AGENT][NEUTRAL] We don't have reference numbers. You can use my name in today's date. Is there anything else I may help you with today?
[CUSTOMER][NEUTRAL] Nope, that'll be all.
[AGENT][POSITIVE] OK, thank you for calling ATO have a good day.
[CUSTOMER][NEUTRAL] You too bye bye.
[AGENT][NEUTRAL] Yeah