AccountId: 011433970860
ContactId: a5971dc2-7f2e-4f04-89a8-4f1b655a06a8
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 194830 ms
Total Talk Time (AGENT): 93284 ms
Total Talk Time (CUSTOMER): 64288 ms
Interruptions: 1
Overall Sentiment: AGENT=1, CUSTOMER=0.3
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/01/16/a5971dc2-7f2e-4f04-89a8-4f1b655a06a8_20250116T16:33_UTC.wav
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[AGENT][NEUTRAL] Thank you for calling APL. This is [PII]. How can I help you?
[CUSTOMER][NEUTRAL] Hi, my name's [PII]. I'm with Advanced ENT and allergy. We have a patient coming into our office that I need to get eligibility and benefits on.
[AGENT][POSITIVE] OK, yeah, I can check eligibility and benefits for you. uh, [PII], can I first get a good call back number from you in case we're disconnected?
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Certainly it's [PII].
[AGENT][NEUTRAL] Mhm.
[AGENT][NEUTRAL] OK, thank you and then do you have the policy number?
[CUSTOMER][NEUTRAL] I do. It is 02544684.
[AGENT][NEUTRAL] OK thank you one moment.
[AGENT][NEUTRAL] All right. And uh what was the name and date of birth for the insured?
[CUSTOMER][NEUTRAL] Um, it is [PII], uh, date of birth is [PII].
[AGENT][NEUTRAL] OK, thank you for verifying that [PII]. Uh, so this policy is active. Effective date was [PII], and this is a limited indemnity medical plan. So essentially it's just set to pay a set dollar amount per procedure or covered off this visit.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] OK, so, uh, it pays like how much does it pay up to visit?
[AGENT][NEUTRAL] OK, so, um, that's what I was gonna ask what kind of benefits this is, uh, just a regular office visit.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] OK, is this um regarding an accident or sickness? OK, so it's gonna be like a consultation.
[CUSTOMER][NEUTRAL] Yeah, they're a new patient coming into our office.
[CUSTOMER][NEUTRAL] Yeah, it's just a consultation they're a new patient for us today or tomorrow.
[AGENT][NEUTRAL] Got it. OK, thank you. Give me just a moment, let me check that out.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] Alright, and of course I will let you know verification of coverage is not a guarantee of payment for claims, um, so their physician's office benefit pays up to $50 per visit, maximum of 4 visits or 4 days per calendar year per covered person.
[CUSTOMER][NEUTRAL] So basically up to 4, you said 4 days, so 4 visits basically?
[AGENT][NEUTRAL] Right.
[AGENT][NEUTRAL] Per covered person per year.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK. Um, and
[CUSTOMER][NEUTRAL] Do have they used any this year?
[AGENT][NEUTRAL] Uh, let me check. Give me just a moment.
[AGENT][NEUTRAL] No, none has been used so far this year.
[CUSTOMER][NEUTRAL] OK, and what was your name again?
[AGENT][NEUTRAL] It's [PII]
[CUSTOMER][NEUTRAL] [PII], can I get a reference number for this call?
[AGENT][NEUTRAL] Yeah, reference number would just be my first name, last initial, and today's date. Uh, so my last initial is [PII] So was there anything else I could help you with, [PII]?
[CUSTOMER][POSITIVE] No, that'll be it thank you so much for your help today.
[AGENT][POSITIVE] Alright, of course, thanks for calling APL. I hope you have a great rest of your day.
[CUSTOMER][NEUTRAL] You too mhm bye bye.
[AGENT][POSITIVE] Thank you, bye bye.