AccountId: 011433970860
ContactId: 99f7da7d-e78d-41e7-9e99-6fce9a3290f2
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 212500 ms
Total Talk Time (AGENT): 105892 ms
Total Talk Time (CUSTOMER): 56522 ms
Interruptions: 0
Overall Sentiment: AGENT=1.4, CUSTOMER=1.8
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/01/03/99f7da7d-e78d-41e7-9e99-6fce9a3290f2_20250103T14:03_UTC.wav
--------------------------------------------
[AGENT][POSITIVE] Good morning. Thank you for calling APL. My name is [PII]. How may I help you?
[CUSTOMER][NEUTRAL] Hi, yes, I'm calling for benefits and eligibility please for one of our patients.
[AGENT][POSITIVE] OK, I'll be more than happy to help you with the benefits and the eligibility. May I have your name and a good contact number in case we're disconnected?
[CUSTOMER][POSITIVE] Yes, of course, it's gonna be [PII].
[CUSTOMER][NEUTRAL] And the phone number is gonna be [PII].
[AGENT][NEUTRAL] Thank you, [PII]. May I have the member's policy number?
[CUSTOMER][NEUTRAL] Yes, of course, the policy number is gonna be 01611760M as in Mike L as in 8.
[AGENT][NEUTRAL] Thank you, hold on one moment.
[CUSTOMER][POSITIVE] No problem.
[AGENT][NEUTRAL] And can you verify the member's first and last name and date of birth?
[CUSTOMER][NEUTRAL] Yes, of course. The patient's name is gonna be for
[CUSTOMER][NEUTRAL] [PII], [PII] of [PII].
[AGENT][NEUTRAL] Thank you for that and all the information provided is a verification of benefits, not a guarantee of payment. So I am showing that the policy is active. It's been effective since [PII].
[AGENT][NEUTRAL] And what type of benefits did you want to go over today?
[CUSTOMER][NEUTRAL] Um, it's gonna be.
[CUSTOMER][NEUTRAL] For office visit and outpatient surgery that's done in the specialist office settings.
[AGENT][NEUTRAL] OK, office visit and outpatient surgery in a specialist office?
[CUSTOMER][NEUTRAL] Mhm. Yes.
[AGENT][NEUTRAL] OK, hold on one moment, I'm just waiting for the benefits to populate here.
[CUSTOMER][POSITIVE] Thank you.
[AGENT][POSITIVE] You're welcome.
[AGENT][NEUTRAL] OK, it just popped up.
[AGENT][NEUTRAL] OK, so for outpatient, the benefit is up to $1500 per covered person per calendar year.
[AGENT][NEUTRAL] There's no deductible.
[AGENT][NEUTRAL] In terms of the office visit, they do have the office treatment rider in which the treatment in the office, as long as it's not cosmetic, should be covered up to that 1500 per year.
[AGENT][NEUTRAL] Now the outpatient surgery, they do have um
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] Surgery in a hospital outpatient facility or in a free-standing outpatient surgery center, but if it's in a specialist office, then that office treatment rider would still come into effect.
[CUSTOMER][POSITIVE] OK, perfect. And how much has been accumulated?
[AGENT][NEUTRAL] For this year?
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] Um, let me see if they've used any yet.
[AGENT][NEUTRAL] No, she hasn't used any um benefits for [PII].
[CUSTOMER][NEUTRAL] OK, perfect. Um, and the reference number?
[AGENT][NEUTRAL] So there's no call reference number, but you can use my name in today's date. The first initial to my last name is [PII].
[AGENT][NEUTRAL] And uh my name is [PII]
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][POSITIVE] Thank you so much, [PII], you have a great rest of your day, OK? Happy Friday.
[AGENT][POSITIVE] Thank you. You also, [PII], and again, all the information provided was a verification of benefits, not a guarantee of payment, and thank you for calling APL and happy New Year.
[CUSTOMER][POSITIVE] Happy New Year. Bye.
[AGENT][POSITIVE] Thank you.