AccountId: 011433970860
ContactId: 9672463e-55d9-4682-903b-4d33ea22f73d
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 266329 ms
Total Talk Time (AGENT): 117262 ms
Total Talk Time (CUSTOMER): 81021 ms
Interruptions: 0
Overall Sentiment: AGENT=0.2, CUSTOMER=0.7
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/06/19/9672463e-55d9-4682-903b-4d33ea22f73d_20250619T14:51_UTC.wav
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[AGENT][NEUTRAL] Thanks for calling APL. This is [PII]. How may I assist you?
[CUSTOMER][NEUTRAL] Hi [PII], this is [PII]. I'm calling from Advanced Orthopedics of Oklahoma. I'm just need to verify patients eligibility and benefits.
[AGENT][NEUTRAL] Sure, I can assist you with that. Can I have a spelling of your name and a callback number?
[CUSTOMER][NEUTRAL] Yes, [PII]
[CUSTOMER][NEUTRAL] And then that phone number is [PII].
[AGENT][NEUTRAL] And what is the policy number of the member that you're calling to verify eligibility for today?
[CUSTOMER][NEUTRAL] I have 02576659.
[AGENT][NEUTRAL] [PII], could you verify the patient's name and date of birth?
[CUSTOMER][NEUTRAL] Yes, [PII], date of birth is [PII].
[AGENT][NEUTRAL] And this is for medical or dental because this is a dental policy.
[CUSTOMER][NEUTRAL] So this is for medical, so they have no medical coverage.
[AGENT][NEUTRAL] So let me apparently they gave you the wrong policy number. What is the date of birth?
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Um, [PII].
[AGENT][NEUTRAL] So let me give you the correct policy number.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] It is 2576658.
[CUSTOMER][NEUTRAL] 2576658
[AGENT][NEUTRAL] And this policy has been active since [PII] and it's currently active.
[AGENT][NEUTRAL] The member has an office visit of $50 per visit with 5 visits per calendar year, and this is not a guaranteed benefits, just a disclaimer of the policy's coverage.
[CUSTOMER][NEUTRAL] And how many of the fire do they have left remaining?
[AGENT][NEUTRAL] Mm.
[AGENT][NEUTRAL] 4 I think it's 4 calendar year. Give me one moment.
[AGENT][NEUTRAL] I thought it was 5. OK, so it's 4 visits per calendar year and she's utilized like all 4 per visit.
[AGENT][NEUTRAL] And the benefit amount that I gave you is not a guaranteed beneficial just a disclaimer on the policy's coverage.
[CUSTOMER][NEUTRAL] Sorry, did you say she used all of her visits?
[AGENT][NEUTRAL] Yeah, she has utilized her 4 visits for the calendar year.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] So that would go back to patient responsibility then I'm assuming?
[AGENT][NEUTRAL] I
[AGENT][NEUTRAL] Um, this is not a primary insurance company, so I can't tell you that. I can just verify that her benefits were maxed out and you to submit a claim and we're gonna process it as follows.
[CUSTOMER][NEUTRAL] Oh, OK.
[CUSTOMER][NEUTRAL] It's a secondary OK.
[CUSTOMER][NEUTRAL] OK, so this is secondary is this uh is this a cap policy?
[AGENT][NEUTRAL] No, this is not a gap policy. This is a hospital indemnity policy.
[CUSTOMER][POSITIVE] Awesome and then this will show as the patient's secondary insurance.
[AGENT][NEUTRAL] I'm not sure cause we don't.
[AGENT][NEUTRAL] I'm not sure. I don't, I'm not affiliated with any other insurance company. I just can verify the benefits here for this one, and it doesn't show in the system about another one.
[CUSTOMER][NEUTRAL] Have that on file OK.
[CUSTOMER][NEUTRAL] OK
[CUSTOMER][NEUTRAL] 578.
[CUSTOMER][NEUTRAL] OK
[CUSTOMER][NEUTRAL] The
[CUSTOMER][NEUTRAL] And you said there was a $50 co-pay, is that what you said?
[AGENT][NEUTRAL] No, I said there was a $50 benefit amount that we pay towards the office visit.
[CUSTOMER][POSITIVE] A benefit amount. OK, thank you.
[CUSTOMER][POSITIVE] OK, thank you.
[CUSTOMER][NEUTRAL] OK, 40.
[CUSTOMER][NEUTRAL] amount here.
[AGENT][NEUTRAL] And we don't provide reference numbers [PII], but you can use my name and today's date as a reference.
[CUSTOMER][NEUTRAL] OK
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Alright, well I think that's all I was eating, so um with that reference number, that's all I have.
[AGENT][NEUTRAL] Um, my name is [PII], and you can use that as a reference number because it stated we don't provide reference numbers.
[CUSTOMER][POSITIVE] OK alright well thank you so much for your help today.
[AGENT][POSITIVE] You're welcome thanks for calling APL. Have a great day. Goodbye.
[CUSTOMER][NEUTRAL] You too bye bye.