AccountId: 011433970860
ContactId: 9d2f76f4-fa90-481f-84a1-f62e62ebab06
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 188160 ms
Total Talk Time (AGENT): 101932 ms
Total Talk Time (CUSTOMER): 42009 ms
Interruptions: 1
Overall Sentiment: AGENT=0.6, CUSTOMER=0.7
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/05/21/9d2f76f4-fa90-481f-84a1-f62e62ebab06_20250521T16:57_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 Mount Sinai Medical Center. I need to verify coverage please for one member.
[AGENT][NEUTRAL] OK, I'm just need to check eligibility.
[CUSTOMER][NEUTRAL] Yes.
[AGENT][NEUTRAL] Alrighty, I can check that for you. uh, [PII], can I get a good call back number from you first in case we're disconnected?
[CUSTOMER][NEUTRAL] Sure, it's area code [PII].
[AGENT][NEUTRAL] Thank you and then do you have the policy number?
[CUSTOMER][NEUTRAL] I do. 02606689.
[AGENT][NEUTRAL] OK and then what was the name and date of birth for the member please?
[CUSTOMER][NEUTRAL] [PII], [PII].
[AGENT][POSITIVE] Perfect, thank you for verifying that. So this policy is active. The 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.
[CUSTOMER][NEUTRAL] OK. And what is the maximum amount that the policy will pay?
[AGENT][NEUTRAL] Uh, is this gonna be for inpatient or outpatient services? OK, I can check that. Give me just a moment. Got it. And of course I will let you know verification of coverage is not a guarantee of payment for claims. Give me just a moment, let me try to find that.
[CUSTOMER][NEUTRAL] To outpatient.
[CUSTOMER][NEUTRAL] Outpatient.
[CUSTOMER][NEUTRAL] Of course.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] So for this policy inpatient and outpatient benefits are combined into one and that amount is $8150 per calendar year. If you'll give me one moment, I will see if any of that has been used.
[CUSTOMER][POSITIVE] Thank you.
[AGENT][NEUTRAL] OK, so he has used $527.46 so far this year.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] And just the claims address, please.
[AGENT][NEUTRAL] Sure, I've also got a fax number and a pair ID if you'd like that as well. Um, our mailing address is [PII].
[AGENT][NEUTRAL] [PII].
[AGENT][NEUTRAL] And that is in [PII].
[AGENT][NEUTRAL] Zip code is [PII].
[CUSTOMER][NEUTRAL] Mhm, and the fax.
[AGENT][NEUTRAL] But it's 877.
[AGENT][NEUTRAL] 3659423
[CUSTOMER][POSITIVE] OK. That is it. I'm all set. Thank you so much and you have a wonderful day.
[AGENT][POSITIVE] Alright, awesome of course thanks for APO you too bye bye.
[CUSTOMER][NEUTRAL] Bye bye.