AccountId: 011433970860
ContactId: 9717bfcd-29bf-4439-b626-6f9ee387269b
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 213600 ms
Total Talk Time (AGENT): 111581 ms
Total Talk Time (CUSTOMER): 55778 ms
Interruptions: 0
Overall Sentiment: AGENT=0.6, CUSTOMER=1.6
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/02/03/9717bfcd-29bf-4439-b626-6f9ee387269b_20250203T17:36_UTC.wav
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[AGENT][NEUTRAL] Thank you for calling APL. This is [PII]. How can I help you?
[CUSTOMER][NEUTRAL] Thank you. I need to check benefit and eligibility for specialist office visit also for procedures done in office setting.
[AGENT][POSITIVE] OK, I can take those benefits for you. um, what was your name? I'm sorry?
[CUSTOMER][NEUTRAL] [PII], and what is your name?
[AGENT][NEUTRAL] It's [PII] and [PII], can I get a good call back number from you in case we're disconnected?
[CUSTOMER][NEUTRAL] Yeah, [PII].
[AGENT][NEUTRAL] Mhm.
[AGENT][NEUTRAL] Alright, thank you. And then do you have the policy number?
[CUSTOMER][NEUTRAL] Yeah, the policy number is 01611608ML8.
[AGENT][NEUTRAL] Alright, thank you. And what was the name and date of birth for the insured?
[CUSTOMER][NEUTRAL] [PII], [PII].
[AGENT][NEUTRAL] Alright, thank you for verifying that [PII]. Uh, so this policy is active. Effective date was [PII], and this is a secondary medical policy, so it is designed to help with co-pay, deductible and co-insurance after major medical pays. And if you'll give me one moment, I will get those the policy pulled up here and see we were needing to see if specialist office visits were covered as well as treatment received in office, correct?
[CUSTOMER][POSITIVE] Please, yes, thank you.
[AGENT][NEUTRAL] OK, of course, one moment please.
[CUSTOMER][NEUTRAL] OK
[AGENT][NEUTRAL] OK, and so [PII], I will say of course, uh, verification of coverage is not a guarantee of payment for claims, so office visits themselves are not covered under this policy. However, treatment received in office could be.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Please.
[AGENT][NEUTRAL] Yes, that that's it so the just the office visits themselves are not covered, um, but treatment in offices.
[CUSTOMER][NEUTRAL] Uh-huh. How much is the benefit?
[AGENT][NEUTRAL] Um, that would be a part of their outpatient benefit. Give me just a moment, let me check and see what that is.
[AGENT][NEUTRAL] There we go, OK, so their outpatient benefit is $1500 per calendar year. If you'll give me one moment, I will see if any of that has been used.
[CUSTOMER][POSITIVE] Please thank you.
[AGENT][NEUTRAL] Of course, alright, none has been used so far that year they do have that full benefit amount.
[CUSTOMER][NEUTRAL] So they can do any diagnostic testing in office, right?
[AGENT][NEUTRAL] Right, um, treatment received in office is covered, um, but the visit itself would not be so if it was simply a consultation, uh, something like that, that would not be covered.
[CUSTOMER][POSITIVE] Perfect. Can I have a reference number for this call?
[AGENT][NEUTRAL] Reference number would just be my first name, last initial, and today's date, uh, so my last initial is [PII], was there anything else I could help you with, [PII]?
[CUSTOMER][POSITIVE] Thank you [PII]. I appreciate it have a nice day.
[AGENT][POSITIVE] Yeah, thanks for calling APL you too bye bye.
[CUSTOMER][NEUTRAL] Bye bye.