AccountId: 011433970860
ContactId: 9cff6780-8e64-4706-af8c-52afc315063e
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 163919 ms
Total Talk Time (AGENT): 89220 ms
Total Talk Time (CUSTOMER): 64758 ms
Interruptions: 2
Overall Sentiment: AGENT=0.7, CUSTOMER=0.8
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/04/21/9cff6780-8e64-4706-af8c-52afc315063e_20250421T19:27_UTC.wav
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[AGENT][NEUTRAL] Thank you for calling APL. This is [PII]. How can I help you?
[CUSTOMER][NEUTRAL] Hi [PII], my name is [PII]. I'm calling from South Florida ENT. I was calling to check, uh, eligibility and benefits on a patient.
[AGENT][POSITIVE] OK, yeah, I could check eligibility benefits for you. [PII], can I get a good call back number from you first in case we're disconnected?
[CUSTOMER][NEUTRAL] Sure it's [PII].
[CUSTOMER][NEUTRAL] [PII] and my extension is [PII].
[AGENT][NEUTRAL] Got it. Thank you. Uh, and then do you have the policy number?
[CUSTOMER][NEUTRAL] Sure it is 101611873.
[CUSTOMER][NEUTRAL] M18 or MI8?
[AGENT][NEUTRAL] OK, and then what was the name and date of birth for the member, please?
[CUSTOMER][NEUTRAL] Um, [PII] and her date of birth is [PII].
[AGENT][NEUTRAL] Perfect, thank you for verifying that. 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 we're needing to look at, uh, inpatient or outpatient benefits.
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] Uh
[CUSTOMER][NEUTRAL] Outpatient.
[AGENT][NEUTRAL] OK, and of course I will let you know verification of coverage is not a guarantee of payment for claims. Uh, the outpatient benefit is $1500 max per calendar year. If you'll give me one moment, I'll see if any of that has been used.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] OK, none has been used so far this year.
[CUSTOMER][NEUTRAL] Perfect and that you said for a specialist office that covers the co-payment and um deductible?
[AGENT][NEUTRAL] Um, let me see if office visits are covered under this policy. One moment.
[CUSTOMER][NEUTRAL] Sure.
[AGENT][NEUTRAL] OK, so under this policy, office visits are not covered. However, treatment received in office could be. So if it was something like a consultation that would not be covered, but if they were to receive treatment, that could be.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][POSITIVE] Mhm. OK, perfect. OK, alright, perfect, thank you so much [PII]. Is there a reference number I can have?
[AGENT][NEUTRAL] All right.
[AGENT][NEUTRAL] Of course.
[AGENT][NEUTRAL] Sure, that would just be my first name, last initial, and today's date and so my name is spelled [PII] And was there anything else I could help you with, [PII]?
[CUSTOMER][POSITIVE] No, that's it. Thank you so much. I appreciate your help, [PII].
[AGENT][POSITIVE] Alright, yeah, thanks for calling APL hope you have a great rest of your day.
[CUSTOMER][NEUTRAL] You too bye bye.
[AGENT][NEUTRAL] Bye bye.