AccountId: 011433970860
ContactId: 9e829500-a598-40a2-855d-c04f8162b96b
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 336559 ms
Total Talk Time (AGENT): 113016 ms
Total Talk Time (CUSTOMER): 136491 ms
Interruptions: 3
Overall Sentiment: AGENT=0.7, CUSTOMER=0.6
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/04/08/9e829500-a598-40a2-855d-c04f8162b96b_20250408T18:12_UTC.wav
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[AGENT][NEUTRAL] My sister.
[CUSTOMER][NEUTRAL] Hi, good afternoon. My name is [PII] and I'm calling from Bapti South Station.
[AGENT][POSITIVE] Hey [PII], how can I assist you today?
[CUSTOMER][NEUTRAL] I'm calling to check, yes, I'm calling to check if the patient have outpatient benefits, please.
[AGENT][NEUTRAL] Sure, I can assist you with that, [PII]. Can I have your callback number?
[AGENT][NEUTRAL] And the policy number of the member.
[CUSTOMER][NEUTRAL] 786
[CUSTOMER][NEUTRAL] [PII]
[CUSTOMER][NEUTRAL] And the policy number, it is 01708000.
[AGENT][NEUTRAL] That's not enough numbers. Could you look at the card to verify if that's the correct number you gave me?
[CUSTOMER][NEUTRAL] OK. Yeah.
[CUSTOMER][NEUTRAL] Let me see if we have the card imaging. Give me one second, please.
[AGENT][POSITIVE] Sure, take your time.
[CUSTOMER][NEUTRAL] OK, so I see policy slash set number 01708000.
[AGENT][NEUTRAL] Could you verify the patient's name and date of birth?
[CUSTOMER][NEUTRAL] So the patient's name, it is [PII]. Date of birth is [PII].
[AGENT][POSITIVE] Thank you.
[CUSTOMER][POSITIVE] You're welcome.
[AGENT][NEUTRAL] And you're calling to verify benefits eligibility for outpatient services.
[CUSTOMER][NEUTRAL] Yes, to check if the patient has outpatient.
[AGENT][NEUTRAL] This number is
[AGENT][NEUTRAL] This member's policy has been active since [PII] and is currently active.
[AGENT][NEUTRAL] The member has outpatient benefits of $500 per occurrence, and this is not a guaranteed benefits, just a disclaimer of the policy's coverage. And when I say per occurrence, meaning as in $500 for if it's the same ICD, the same reason like say if I go for a broken thumb, if whatever visits that I go through in regards to that broken thumb pertaining to the broken thumb that is considered as a per occurrence.
[CUSTOMER][NEUTRAL] OK, so let's say that the patient has two exams like an X-ray and an ultrasound. Those $500 will be covered those two exams or each exam has up to $500.
[AGENT][NEUTRAL] No. No, just those 2 exams. It'll cover up the 2 exams.
[CUSTOMER][NEUTRAL] OK, so it those two, it will be up to 500 for both.
[AGENT][NEUTRAL] Say if the 500 was exhausted on one of the exams.
[AGENT][NEUTRAL] Right, so say if the um the 500 was exhausted with the X-ray and then they have something for the same reason, but the benefits are exhausted, so that means that there won't be a payment made on it.
[CUSTOMER][NEUTRAL] Oh
[AGENT][NEGATIVE] Because the benefits were exhausted.
[CUSTOMER][NEUTRAL] OK, so it basically it is up for date like up to an appointment only for the appointment.
[AGENT][NEUTRAL] No, no, it's per occurrence, per occurrence, meaning as in for the same ICD code, for the same reason.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Got it.
[CUSTOMER][NEUTRAL] benefit of
[AGENT][NEUTRAL] And what was your name? Did you say your name was [PII]?
[CUSTOMER][NEUTRAL] No, [PII].
[AGENT][POSITIVE] Oh, [PII] I gave you a whole new name.
[CUSTOMER][NEUTRAL] No, it's OK.
[CUSTOMER][NEUTRAL] OK, so the $500 it is up to per same I see the same.
[AGENT][NEUTRAL] Yes, same per per occurrence.
[CUSTOMER][NEUTRAL] [PII]?
[AGENT][NEUTRAL] Yeah, per occurrence like occurrence is in the same occurrence reason.
[CUSTOMER][NEUTRAL] Like occurrence is spells A C C U R A N C E.
[AGENT][NEUTRAL] It is spelled
[AGENT][NEUTRAL] Mm. 0 cc U R A N C E.
[CUSTOMER][NEUTRAL] Oh, OK. So it's 0 cc U R A N C E?
[AGENT][NEUTRAL] Yes.
[CUSTOMER][NEUTRAL] OK, I got it.
[CUSTOMER][NEUTRAL] OK per.
[CUSTOMER][NEUTRAL] Got it.
[CUSTOMER][NEUTRAL] OK. Um, may I have one more time your name, the initial of your last name, and a reference number, please?
[AGENT][NEUTRAL] My name is [PII] and today's date is a reference.
[CUSTOMER][NEUTRAL] And what is the initial of your last name?
[AGENT][NEUTRAL] [PII].
[CUSTOMER][NEUTRAL] And, and what is your time zone, Ms. [PII]?
[AGENT][NEUTRAL] Um, central.
[CUSTOMER][POSITIVE] Central perfect thank you so much for your help.
[CUSTOMER][POSITIVE] So it's [PII] central time. OK, thank you so much for your help. Have a good day.
[AGENT][POSITIVE] Thanks for calling APL. You have a great one as well. Goodbye, [PII].
[CUSTOMER][NEUTRAL] Likewise. Bye-bye.