AccountId: 011433970860
ContactId: 9704f2bb-ff20-4759-8637-d3770da32856
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 267339 ms
Total Talk Time (AGENT): 121533 ms
Total Talk Time (CUSTOMER): 118195 ms
Interruptions: 5
Overall Sentiment: AGENT=0.8, CUSTOMER=0.8
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/05/27/9704f2bb-ff20-4759-8637-d3770da32856_20250527T19:31_UTC.wav
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[AGENT][NEUTRAL] Thank you for calling APL. This is [PII]. How may I help you?
[CUSTOMER][NEUTRAL] Hi, [PII]. My name is [PII]. It's [PII] and then you should is [PII]. I'm calling from provider's office and I'm looking for eligibility and benefits for the patient for specialist office visit.
[AGENT][NEUTRAL] OK, I can help you with eligibility and benefits, Ms. [PII]. What is your callback number just in case the call is disconnected?
[CUSTOMER][NEUTRAL] Yeah, the callback number is [PII] and the extension is [PII].
[AGENT][NEUTRAL] Thank you. And then may I get the patient's name, date of birth, and policy number?
[CUSTOMER][NEUTRAL] Yeah, the patient's name is [PII]. Their date of birth is [PII] and their ID is 02574984 [PII].
[CUSTOMER][NEUTRAL] And
[AGENT][NEUTRAL] Thank you and then may I have the name of the facility you're calling from?
[CUSTOMER][NEUTRAL] So
[CUSTOMER][NEUTRAL] I'm calling from [PII] provider's office.
[AGENT][POSITIVE] OK, thank you, let me look up that member real quick.
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] Yeah, sure.
[CUSTOMER][NEUTRAL] I
[CUSTOMER][NEUTRAL] A as in apple, D as in Delta, A as in apple.
[AGENT][NEUTRAL] OK, I do show that [PII] does have an active policy. The effective date of her policy is [PII].
[CUSTOMER][NEUTRAL] It
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] And this is just to verify benefits. It's not a guarantee of payment. She has a supplemental insurance policy that is billed secondary to the primary. It helps with the deductible, co-pay, and co-insurance. She has an inpatient calendar year benefit amount of $2500.
[CUSTOMER][NEUTRAL] Both the
[CUSTOMER][NEUTRAL] Yeah
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] And and.
[AGENT][NEUTRAL] And an outpatient calendar year benefit amount of $2500.
[CUSTOMER][NEUTRAL] 88065.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] To go towards deductible, co-pay or co-insurance.
[CUSTOMER][NEUTRAL] OK. And could you please confirm me the patient responsibility for the specialist office visit?
[AGENT][NEUTRAL] The, I don't know what the patient responsibility would be.
[AGENT][NEUTRAL] It all depends on the diagnosis codes and procedure codes. I do know that this policy only covers deductible, co-pay, and co-insurance.
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] Do you
[CUSTOMER][NEUTRAL] OK. So the, if the patient can see the specialist, so the services are covered. Is that correct?
[AGENT][NEUTRAL] Let me look and see if
[AGENT][NEUTRAL] She has office visits on her policy.
[CUSTOMER][NEUTRAL] Yes.
[AGENT][NEUTRAL] It'll be just a moment, let me pull in the policy certificate so I can look at that for you.
[CUSTOMER][POSITIVE] Yeah, sure, no problem. You can take your time.
[AGENT][POSITIVE] Thank you.
[AGENT][NEUTRAL] OK. The insured um does have
[AGENT][NEUTRAL] Treatment in an office, but the physician's covered charges are not covered.
[CUSTOMER][NEUTRAL] ID.
[CUSTOMER][NEUTRAL] OK, so the physician's covered charges are not.
[AGENT][NEUTRAL] So she doesn't have, right.
[AGENT][NEUTRAL] Right, she doesn't have office visits.
[CUSTOMER][NEUTRAL] Of
[CUSTOMER][NEUTRAL] OK. OK, so only the office treatment like diseases, any injection done in the office that are covered, but the office visit services are not covered.
[AGENT][NEUTRAL] Right.
[AGENT][POSITIVE] Correct.
[CUSTOMER][POSITIVE] Thank you so much for that information and it's all for today. Could you please spell out your name for me?
[AGENT][NEUTRAL] Yes, ma'am. It's [PII]
[CUSTOMER][NEUTRAL] And make it initial to your last name.
[AGENT][NEUTRAL] A
[CUSTOMER][POSITIVE] Thank you, [PII] for assisting me. Have a great day ahead. Thank you. Bye-bye.
[AGENT][POSITIVE] You too, [PII]. Thank you for calling APL. You have a wonderful week. Bye bye.
[CUSTOMER][POSITIVE] Thank you. Bye-bye.