AccountId: 011433970860
ContactId: a393b9bb-f58c-449f-ae64-3e120123ba87
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 196949 ms
Total Talk Time (AGENT): 119989 ms
Total Talk Time (CUSTOMER): 49723 ms
Interruptions: 0
Overall Sentiment: AGENT=1.6, CUSTOMER=1.3
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/03/19/a393b9bb-f58c-449f-ae64-3e120123ba87_20250319T20:28_UTC.wav
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[AGENT][POSITIVE] Good afternoon thank you for calling APL. My name is [PII]. How may I help you?
[CUSTOMER][NEUTRAL] Hi [PII], my name is [PII] and I'm looking to verify benefits for some patients.
[AGENT][POSITIVE] And so that I can help you with benefits. What is a good callback number?
[CUSTOMER][NEUTRAL] [PII], no extension.
[AGENT][NEUTRAL] Thank you, [PII], and the policy number for the patient, please?
[CUSTOMER][NEUTRAL] 02145415
[AGENT][NEUTRAL] And the patient's name and date of birth, please.
[CUSTOMER][NEUTRAL] [PII], [PII].
[AGENT][POSITIVE] All right, thank you.
[AGENT][NEUTRAL] [PII], I'm showing
[AGENT][NEUTRAL] [PII]'s policy is active. Effective date is [PII]. This is a secondary policy to his primary insurance, and what type of benefits are you needing?
[CUSTOMER][NEUTRAL] Um, this is for a sleep study outpatient hospital with the code 95811.
[AGENT][NEUTRAL] OK, he does have outpatient coverage up to $8000 per calendar year. That is the max that we can pay toward his deductible, co-pay or co-insurance of his major medical. That will be done in an outpatient facility.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] OK. So that could be covered under that outpatient benefit. Now, that is a verification.
[CUSTOMER][NEUTRAL] Has he used any?
[AGENT][NEUTRAL] Uh, he, uh, right now he's used $100 of that benefit for 2025 and all benefits given over the phone is a verification of coverage and not a guarantee of payment.
[CUSTOMER][NEUTRAL] Thank you, and I do have one more patient to verify, but can I have the reference number for this one?
[AGENT][NEUTRAL] Absolutely, give me just one second and let me notate this. The reference number is the same for the whole call. It's my name and today's date, and I spell my name [PII].
[CUSTOMER][POSITIVE] Thank you and let me know when you're ready for the next member lady.
[AGENT][POSITIVE] I am just about ready. All right, [PII], I'm ready.
[CUSTOMER][NEUTRAL] 237-0362
[AGENT][NEUTRAL] And that name and date of birth?
[CUSTOMER][NEUTRAL] [PII], [PII].
[AGENT][NEUTRAL] Thank you. Is it for the same outpatient benefit?
[CUSTOMER][NEUTRAL] Yes.
[AGENT][NEUTRAL] All right, thank you. Enjoy his [PII]'s policy is active. Effective date is [PII]. He has outpatient coverage up to.
[AGENT][NEUTRAL] $2500 per calendar year. At this time, he has that full benefit remaining for 2025 and that is a verification of coverage, not a guarantee of payment.
[CUSTOMER][POSITIVE] All right, [PII], that is all I needed today. Thank you so much for all of your help and I hope you enjoy the rest of your day.
[AGENT][POSITIVE] And thank you, [PII], for calling APL. Hope you have a wonderful afternoon as well, and it was a pleasure to assist you with those benefits. Thank you.
[CUSTOMER][POSITIVE] Thank you. Goodbye.
[AGENT][NEUTRAL] Bye bye.