AccountId: 011433970860
ContactId: 9a239cd6-7900-4bbf-99a7-23280a62d2f6
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 219190 ms
Total Talk Time (AGENT): 103665 ms
Total Talk Time (CUSTOMER): 64672 ms
Interruptions: 0
Overall Sentiment: AGENT=0.3, CUSTOMER=1
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/04/09/9a239cd6-7900-4bbf-99a7-23280a62d2f6_20250409T12:31_UTC.wav
--------------------------------------------
[AGENT][NEUTRAL] Thank you for calling APL. This is [PII]. How may I help you?
[CUSTOMER][NEUTRAL] Um, hi, good morning, uh, my name is [PII] calling from, uh, a provider's office. I would just like to get benefit information for one of our patients.
[AGENT][NEUTRAL] OK, I can help you. Can you spell your first name, please?
[CUSTOMER][NEUTRAL] [PII]
[AGENT][NEUTRAL] [PII], OK. And is this for
[CUSTOMER][NEUTRAL] [PII] is my initial. Yeah.
[AGENT][NEUTRAL] OK, thank you and is this for service in a doctor's office or outpatient facility?
[CUSTOMER][NEUTRAL] Doctor's office.
[AGENT][NEUTRAL] OK. If I can get the policy number and your phone number in case we're disconnected.
[CUSTOMER][NEUTRAL] My phone number is [PII] and then the member ID is 02611522.
[AGENT][POSITIVE] Thank you.
[CUSTOMER][NEUTRAL] Can I have your name and your initial?
[AGENT][NEUTRAL] It's [PII]
[AGENT][NEUTRAL] First initial last is [PII].
[AGENT][NEUTRAL] [PII], what's the patient's name and date of birth? Uh-huh, you're welcome.
[CUSTOMER][POSITIVE] Thank you [PII].
[CUSTOMER][NEUTRAL] [PII], you're welcome. Uh, [PII], [PII].
[AGENT][NEUTRAL] OK, thank you. And we're checking benefits for service in a doctor's office, correct?
[CUSTOMER][NEUTRAL] Yes, specialist office visit.
[AGENT][NEUTRAL] All right, I show the
[AGENT][NEUTRAL] OK, I show the policy effective date is [PII], currently active at this time?
[AGENT][NEUTRAL] And
[AGENT][NEUTRAL] Let me look at the benefits here.
[AGENT][NEUTRAL] So the physician visit fee is not covered?
[AGENT][NEUTRAL] Um, but covered treatment can be considered.
[AGENT][NEGATIVE] So the copay is not covered.
[CUSTOMER][NEUTRAL] What's the outpatient benefit maximum?
[AGENT][NEUTRAL] OK, are you needing the outpatient benefit?
[CUSTOMER][NEUTRAL] Yeah, what's the maximum?
[AGENT][NEUTRAL] OK, so for service outside of an office visit setting, the maximum benefit, one moment.
[AGENT][NEUTRAL] It is up to $6500. That's per covered person.
[AGENT][NEUTRAL] Per calendar year and actually the inpatient and the outpatient benefit is combined.
[AGENT][NEUTRAL] It's a combined benefit of 6500.
[AGENT][NEUTRAL] Per calendar year.
[CUSTOMER][NEUTRAL] Alright, what's the accumulation as of today?
[AGENT][NEUTRAL] And of course the information provided is verification only, not a guarantee of payment. So if I'm checking for outpatient which is services in a location other than an office, none of that benefit has been used.
[CUSTOMER][NEUTRAL] Got it. And is there like a group number for this plan?
[AGENT][NEUTRAL] There he is. I'll provide that for you. It's also located on the ID card. That number is 27031.
[CUSTOMER][NEUTRAL] Mm.
[CUSTOMER][NEUTRAL] 27031.
[AGENT][POSITIVE] Correct.
[CUSTOMER][NEUTRAL] Oh, got it.
[CUSTOMER][NEUTRAL] Uh, what's the reference number for our call? That's all for me for today. Just the reference number.
[AGENT][NEUTRAL] My name in today's date.
[AGENT][NEUTRAL] My name in today's date.
[CUSTOMER][NEUTRAL] All right, [PII], that will be all.
[AGENT][POSITIVE] Oh, you're, you're welcome, [PII]. No other questions. Thanks for calling APL. Have a good day.
[CUSTOMER][POSITIVE] All right, thank you so much.
[CUSTOMER][POSITIVE] You too bye bye take care.
[AGENT][NEUTRAL] Bye bye.