AccountId: 011433970860
ContactId: 9901e200-436c-4a63-b26c-6bd7df5d6431
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 286390 ms
Total Talk Time (AGENT): 94654 ms
Total Talk Time (CUSTOMER): 73356 ms
Interruptions: 0
Overall Sentiment: AGENT=0.6, CUSTOMER=1.4
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/06/17/9901e200-436c-4a63-b26c-6bd7df5d6431_20250617T19:31_UTC.wav
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[AGENT][NEUTRAL] Thank you for calling APR. This is [PII]. How can I help you?
[CUSTOMER][NEUTRAL] Hi, good afternoon. My name is [PII]. I'm just calling to verify benefits for a patient.
[AGENT][NEUTRAL] I'm sure, [PII] I can assist you with benefits. Um, first, I'll need to go callback number just in case we're disconnected.
[CUSTOMER][NEUTRAL] It'll be [PII].
[AGENT][NEUTRAL] OK. One moment, please.
[AGENT][NEUTRAL] OK, thanks for your patience. Um, what's the policy number, please?
[CUSTOMER][NEUTRAL] 106692201
[AGENT][NEUTRAL] OK. Thank you. Now, please verify the patient's name and date of birth.
[CUSTOMER][NEUTRAL] [PII] [PII].
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] Actually, someone else came up under that policy number. Um, do you have the member's social?
[CUSTOMER][NEUTRAL] Um, no, we don't have a social. I have the last 4.
[AGENT][NEUTRAL] OK, well, I could try to look them up by name and date of birth. What's the last name?
[CUSTOMER][NEUTRAL] But I don't have a phone.
[CUSTOMER][NEUTRAL] Uh.
[CUSTOMER][NEUTRAL] It's [PII]
[AGENT][NEUTRAL] OK
[AGENT][NEUTRAL] And the first name, please?
[CUSTOMER][NEUTRAL] [PII]
[AGENT][NEUTRAL] Mm
[AGENT][NEUTRAL] And her date of birth.
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] OK, I found her in our system and I have her policy number here.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][POSITIVE] I'm ready when you are.
[AGENT][NEUTRAL] OK. The policy number is 010.
[AGENT][NEUTRAL] 6
[AGENT][NEUTRAL] 692-2.
[CUSTOMER][NEUTRAL] All right, so I have 01066922?
[AGENT][NEUTRAL] Yes, ma'am. That's our policy number.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][POSITIVE] Perfect. All right. Um, can you just tell me the effective date, please?
[AGENT][NEUTRAL] Mhm.
[AGENT][NEUTRAL] Um, yes, and just let me advise you that verification of coverage does not guarantee payment of claims. Um, the effective date on this policy was [PII]. The policy is still active, and is this for inpatient or outpatient benefits or an office visit?
[CUSTOMER][NEUTRAL] Outpatient benefits.
[AGENT][NEUTRAL] OK. And for outpatient, we cover up to $500 per occurrence and every occurrence is every 90 days. Um, we'll cover up to $500 for the co-pay, the co-insurance, and the deductible after the primary insurance processes the claim.
[CUSTOMER][POSITIVE] OK, perfect. Thank you so much. Um, quick question, is authorization needed for any outpatient procedures or exams?
[AGENT][NEUTRAL] Um,
[AGENT][NEUTRAL] Right. No, ma'am. Since this is secondary gap insurance, no authorization is required because we go by the primary insurance guidelines.
[CUSTOMER][POSITIVE] OK. Thank you so much.
[AGENT][NEUTRAL] OK. Is there anything else I can assist you with?
[CUSTOMER][NEUTRAL] No, that's all.
[AGENT][POSITIVE] OK. Well, I thank you again, [PII] for calling APL. You have a great rest of your day. Mm bye.
[CUSTOMER][POSITIVE] Thank you you too bye bye.
[AGENT][POSITIVE] Thank you.