AccountId: 011433970860
ContactId: 9f36df9d-fbd2-41f0-8713-47905758e9fb
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 169580 ms
Total Talk Time (AGENT): 82151 ms
Total Talk Time (CUSTOMER): 64104 ms
Interruptions: 0
Overall Sentiment: AGENT=0.7, CUSTOMER=1
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/04/22/9f36df9d-fbd2-41f0-8713-47905758e9fb_20250422T13:17_UTC.wav
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[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] Thank you for calling APL. This is [PII]. How can I help you?
[CUSTOMER][NEUTRAL] Hi, good morning. I'm calling to check uh for benefits for a patient, please.
[AGENT][POSITIVE] Yes, ma'am. I can assist you with benefits. Um, first, could I get your name and a good callback number?
[CUSTOMER][NEUTRAL] Yes, my name is [PII] Last name uh initial [PII] and the callback number is [PII], no extension.
[AGENT][NEUTRAL] OK. Thank you, [PII]. Now, could I get the policy number, please?
[CUSTOMER][NEUTRAL] Sure. I have um the certain number, where is it? 02593385ML8.
[AGENT][NEUTRAL] OK, one moment, please.
[AGENT][NEUTRAL] OK, and please verify the patient's name and date of birth.
[CUSTOMER][NEUTRAL] Sure. Her name is [PII] [PII].
[AGENT][NEUTRAL] OK. Thank you and just let me advise you the verification of coverage does not guarantee payment of claims. Um, the effective date on this policy was [PII]. The policy is still active. And is this for inpatient or outpatient benefits or an office visit?
[CUSTOMER][NEUTRAL] Sure
[CUSTOMER][NEUTRAL] It, it would be for both and then for outpatient, I would like to know if it covers office visit co-pays and ultrasounds or procedures in office.
[AGENT][NEUTRAL] OK, let's see. I'm showing for office treatments, we cover up to 500 per day and that's for the co-insurance and the deductible after the primary insurance processes the claim, but the co-pay for the office visit is not covered.
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] OK, it'll be copays now, right, and then for any other outpatient services?
[AGENT][NEUTRAL] Um, it's 500 per day.
[CUSTOMER][NEUTRAL] OK, and then inpatient?
[AGENT][NEUTRAL] Um, for inpatients.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] For inpatient, we cover up to 4000 per calendar year. And again, that's for the co-pay, co-insurance and deductible after primary insurance.
[CUSTOMER][NEUTRAL] OK
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Has she used any of that benefit?
[AGENT][NEUTRAL] Let's see.
[AGENT][NEUTRAL] Um, no, ma'am. She hasn't used any of our benefits this year.
[CUSTOMER][POSITIVE] Perfect. OK, alright then that's all I needed to know. May I have a reference number for this phone call, please?
[AGENT][NEUTRAL] Yes, for the reference number, you can use my name in today's date. My name is [PII] um it's spelled [PII] Last initial [PII], and today's date. Is there anything else I can assist you with?
[CUSTOMER][NEUTRAL] So if I feel like.
[CUSTOMER][POSITIVE] Wonderful.
[CUSTOMER][POSITIVE] That will be all thank you so much for your help.
[AGENT][POSITIVE] OK, thank you, [PII], for calling ATL. Have a great day. Mm bye.
[CUSTOMER][NEUTRAL] You too bye bye.