AccountId: 011433970860
ContactId: a2dc7bce-2c8b-4d8c-89a6-033f90ddd3b2
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 164740 ms
Total Talk Time (AGENT): 71347 ms
Total Talk Time (CUSTOMER): 79245 ms
Interruptions: 0
Overall Sentiment: AGENT=0.7, CUSTOMER=0.8
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/02/21/a2dc7bce-2c8b-4d8c-89a6-033f90ddd3b2_20250221T17:47_UTC.wav
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[AGENT][POSITIVE] Thanks for calling APL. This is [PII]. How may I assist you?
[CUSTOMER][NEUTRAL] Yeah, hi, this is [PII]. I'm calling from the Nicholas Children's Hospital to check the delivery and benefits.
[AGENT][NEUTRAL] Sure, [PII], I can assist you with that. You did say your name was [PII]?
[CUSTOMER][NEUTRAL] Yes.
[AGENT][NEUTRAL] Can I have a callback number for you and that policy number?
[CUSTOMER][NEUTRAL] OK. It will callback number is [PII].
[CUSTOMER][NEUTRAL] And uh patient member ID is 01611843 M as in Mike, L as in Lima, 8.
[AGENT][NEUTRAL] Thank you, [PII]. Can you verify the patient's name and date of birth that you're inquiring eligible looking for today?
[CUSTOMER][NEUTRAL] OK. It's uh [PII]. Date of birth is [PII].
[CUSTOMER][NEUTRAL] Hey
[AGENT][NEUTRAL] You're calling to verify benefits eligibility for [PII] for what place of service?
[CUSTOMER][NEUTRAL] Yes.
[AGENT][NEUTRAL] What is the place of service inpatient, outpatient office visit?
[CUSTOMER][NEUTRAL] Yeah, it's for uh office visit.
[AGENT][NEUTRAL] This member's policy has been active since [PII] and is currently active. The member's policy does not cover office visits itself, however, the member's policy does have a treatment rider which falls on the outpatient benefits of $1500 per calendar year, and this is not a guaranteed benefits, just a disclaimer of the policy's coverage.
[CUSTOMER][NEUTRAL] I
[CUSTOMER][NEUTRAL] Yeah.
[AGENT][NEUTRAL] Is there anything else that I can assist you with today?
[CUSTOMER][NEUTRAL] OK, you said the effective date is [PII], right?
[AGENT][NEUTRAL] Yes, the policy has been active since [PII].
[CUSTOMER][NEUTRAL] OK. And uh for outpatient specialty benefits, what will be the co-pay?
[AGENT][NEUTRAL] $1500 per calendar year is the benefit amount. This is a gap insurance that assists with deductible, co-pay, and co-insurance.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][POSITIVE] $1500. OK, then. Thank you.
[CUSTOMER][NEUTRAL] And uh is there any um referral or are required for the office visit?
[AGENT][NEUTRAL] No. Office visits are not covered. Only the treatment received in the office.
[CUSTOMER][NEUTRAL] OK
[CUSTOMER][NEUTRAL] I
[AGENT][NEUTRAL] And this is not a guarantee of benefits, just a disclaimer of the policy's coverage.
[CUSTOMER][NEUTRAL] Oh.
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] OK. I said the offer which is not covered under the plan?
[AGENT][NEUTRAL] That's correct, the office visits are not covered under the policy.
[CUSTOMER][NEUTRAL] I
[CUSTOMER][POSITIVE] OK, then. Thank you so much. Um, and can I get the reference number for our call?
[AGENT][NEUTRAL] Don't provide those, [PII], however, you can use my name in today's date as a reference.
[CUSTOMER][POSITIVE] OK, sir. Thank you so much. Have a great day. Bye.
[AGENT][POSITIVE] Thanks for calling APL and you have a great day.
[CUSTOMER][NEUTRAL] Mhm.