AccountId: 011433970860
ContactId: 996e6bc6-cecd-427d-aabb-b82df5d207ea
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 244380 ms
Total Talk Time (AGENT): 98818 ms
Total Talk Time (CUSTOMER): 57133 ms
Interruptions: 0
Overall Sentiment: AGENT=1, CUSTOMER=0.7
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/01/15/996e6bc6-cecd-427d-aabb-b82df5d207ea_20250115T22:02_UTC.wav
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[AGENT][NEUTRAL] Thank you for calling APL. This is [PII]. How can I help you?
[CUSTOMER][POSITIVE] Hi, um, good afternoon, [PII]. I was calling to get eligibility and benefits for a patient.
[AGENT][NEUTRAL] OK, I can check eligibility and benefits for you. Uh, what was your name?
[CUSTOMER][NEUTRAL] Uh my name is [PII]. It's [PII]
[AGENT][NEUTRAL] OK.
[AGENT][POSITIVE] And I, can I get a good call back number from you in case we're disconnected?
[CUSTOMER][NEUTRAL] Yes, it's gonna be [PII].
[AGENT][NEUTRAL] Alright, thank you. And then do you have the policy number?
[CUSTOMER][NEUTRAL] Yes, that's gonna be 02508097, M as in Mike, L as in Lima, 8.
[AGENT][NEUTRAL] Alright, thank you. And what was the name and date of birth for the insured?
[CUSTOMER][NEUTRAL] Um, patient's name is [PII]. Date of birth is [PII].
[AGENT][NEUTRAL] OK, thank you for verifying that. OK. So this policy is active. Effective date was [PII], and this is a secondary medical policy. It is designed to help with co-pay, deductible and co-insurance after major medical pays.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] And we're needing to look at outpatient benefits.
[CUSTOMER][NEUTRAL] Um, yes, it's gonna be for a specialist office visit and then for allergy services.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] OK. One moment, let me make sure that that is going to be covered.
[CUSTOMER][NEUTRAL] Mhm
[CUSTOMER][NEUTRAL] OK.
[AGENT][POSITIVE] Bear with me just a moment, I appreciate your patience.
[CUSTOMER][POSITIVE] Mhm, no problem.
[AGENT][NEUTRAL] OK, so I'm sorry about the wait. I appreciate your patience um, let's see, so of course I will let you know verification of coverage is not a guarantee of payment for claims.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] They've got
[AGENT][NEUTRAL] The office visit itself is not going to be covered.
[AGENT][NEUTRAL] However, treatment in office could be.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK, and then is there like a max?
[AGENT][NEUTRAL] Yes.
[CUSTOMER][NEUTRAL] That the insurance covers.
[AGENT][NEUTRAL] Yes, bear with me just a moment.
[AGENT][NEUTRAL] That outpatient benefit, uh, so it is on a per calendar day basis, so it is $750 max per calendar day.
[CUSTOMER][NEUTRAL] OK, and um, would that include the skin testing, injection, and serum?
[AGENT][NEUTRAL] Um, if this would be in a physician's office environment, is that correct?
[CUSTOMER][NEUTRAL] Mhm, yes.
[AGENT][NEUTRAL] Yes, it could be then it's just the visit itself um is not covered.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] OK, alrighty and then, um, [PII], just to get the first initial to your last name and then just a reference number for the call.
[AGENT][NEUTRAL] Sure, reference number would just be my first name, last initial, and today's date. Uh, so my name is spelled [PII] last initial is [PII] is there anything else I could help you with?
[CUSTOMER][POSITIVE] Um, no, that'll be it. Thank you so much.
[AGENT][POSITIVE] Alright, yeah, thanks for calling APL. I hope you have a great rest of your day.
[CUSTOMER][NEUTRAL] You as well bye bye.
[AGENT][POSITIVE] Thank you bye bye.