AccountId: 011433970860
ContactId: 9e1c5cc1-cd51-4808-811e-b60754d4fe41
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 254720 ms
Total Talk Time (AGENT): 99779 ms
Total Talk Time (CUSTOMER): 85077 ms
Interruptions: 3
Overall Sentiment: AGENT=1.9, CUSTOMER=0.3
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/05/20/9e1c5cc1-cd51-4808-811e-b60754d4fe41_20250520T18:57_UTC.wav
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[CUSTOMER][NEUTRAL] Got it, but I'm a doctor.
[AGENT][POSITIVE] Thank you for calling. This is [PII]. How can I help you?
[CUSTOMER][NEUTRAL] Hi, good afternoon. I'm calling from Cardiology Healthcare, um.
[CUSTOMER][NEUTRAL] To see if I can get the eligibility and benefits of a mutual patient.
[AGENT][POSITIVE] Sure I can help you with eligibility and benefits. Can I get your name and a good call back number in case we get disconnected?
[CUSTOMER][POSITIVE] Thank you for calling Pittsburgh.
[CUSTOMER][NEUTRAL] Yeah
[CUSTOMER][NEUTRAL] [PII] and her number is [PII].
[AGENT][POSITIVE] OK, thank you so much. And can I get the policy number?
[CUSTOMER][NEUTRAL] Um, 025494884 or press 2.
[AGENT][NEUTRAL] OK. One moment.
[CUSTOMER][NEUTRAL] OK
[CUSTOMER][NEUTRAL] One moment while I connect you to the pharmacy.
[AGENT][NEUTRAL] And can I get you to verify the patient's name and date of birth?
[CUSTOMER][NEUTRAL] His name is
[CUSTOMER][NEUTRAL] [PII].
[CUSTOMER][NEUTRAL] Date of birth [PII].
[AGENT][POSITIVE] OK, thank you so much.
[AGENT][NEUTRAL] OK, it looks like this policy is active with an effective date of [PII].
[AGENT][NEUTRAL] And were you needing benefits on something specific?
[CUSTOMER][NEUTRAL] Yes, um, the co-payments for, uh, specialist consult visit, is it covered or?
[AGENT][NEUTRAL] Specialist visit, let me look.
[AGENT][NEUTRAL] And I will say that this policy is a um secondary gap policy. So major medical will need to um approve it as well, and whenever you submit the claim, we will need the major medicals EOB showing that they also accepted the claim.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] And let me see.
[AGENT][NEUTRAL] That specialist visits.
[CUSTOMER][NEUTRAL] Thank you for calling CVS Pharmacy.
[CUSTOMER][NEUTRAL] Press 2 now.
[CUSTOMER][NEUTRAL] option
[CUSTOMER][NEUTRAL] Which would you like?
[AGENT][NEUTRAL] OK, and I do want to remind you that this is just a verification of benefits and not a guarantee of payment. It looks like this policy just has inpatient and outpatient benefit maximums. The inpatient benefit maximum is up to $6000 per covered person per calendar year.
[CUSTOMER][NEUTRAL] Of
[CUSTOMER][NEUTRAL] What is that?
[CUSTOMER][NEUTRAL] Do
[CUSTOMER][NEUTRAL] One.
[AGENT][NEUTRAL] The outpatient benefit maximum is the same, up to $6000 per covered person per calendar year.
[CUSTOMER][NEUTRAL] OK
[CUSTOMER][NEUTRAL] So do you by any chance know if that includes um the co-payment for a console visit?
[CUSTOMER][NEUTRAL] With a specialist or?
[AGENT][NEUTRAL] This policy should, let me double check.
[AGENT][POSITIVE] Because this does help pay for co-insurance, co-pay, and co-deductible. So let me just make sure, mhm.
[CUSTOMER][NEUTRAL] Oh, OK.
[AGENT][NEUTRAL] Um,
[CUSTOMER][NEUTRAL] [PII]
[AGENT][NEUTRAL] Yes, ma'am. And I'm not seeing anything excluding a specialist visit.
[CUSTOMER][NEUTRAL] They
[CUSTOMER][NEUTRAL] Oh OK.
[AGENT][NEUTRAL] OK. Is there anything else I can help you with?
[CUSTOMER][NEUTRAL] Alright, that will be it then.
[AGENT][POSITIVE] OK, well, thank you so much for calling APL and have a great day.
[CUSTOMER][POSITIVE] Thank you you too.
[AGENT][NEUTRAL] Bye.
[CUSTOMER][NEUTRAL] Yes bye bye.