AccountId: 011433970860
ContactId: a626afa5-9e43-4fa7-be6c-2d2c1d848b1a
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 428839 ms
Total Talk Time (AGENT): 162906 ms
Total Talk Time (CUSTOMER): 154738 ms
Interruptions: 4
Overall Sentiment: AGENT=0.4, CUSTOMER=0.8
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/04/09/a626afa5-9e43-4fa7-be6c-2d2c1d848b1a_20250409T18:14_UTC.wav
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[AGENT][NEUTRAL] Thank you for calling APL. This is [PII]. How may I help you?
[CUSTOMER][NEUTRAL] Hi, um, good afternoon, [PII]. I was calling to get eligibility and benefits for 2 patients.
[AGENT][POSITIVE] OK, I can help you with eligibility and benefits for the patients. Can I please get your name and your callback number?
[CUSTOMER][NEUTRAL] Yes, uh, my name is [PII] Callback number is [PII].
[AGENT][NEUTRAL] OK, thank you ma'am and then what is the name of the facility you're calling from?
[CUSTOMER][NEUTRAL] OK, thank you ma'am. And then what is the name of the facility you're calling from? It's asthma and allergy associated to Florida.
[AGENT][NEUTRAL] OK. And may I get the first patient's name, date of birth, and policy number?
[CUSTOMER][NEUTRAL] OK, and
[CUSTOMER][NEUTRAL] Patient's name is [PII]. Date of birth is [PII].
[CUSTOMER][NEUTRAL] Member's ID is 02409001 M as in [PII].
[AGENT][NEUTRAL] OK, let me pull that up real quick.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] OK, I do show that [PII] does have an active policy.
[CUSTOMER][NEUTRAL] That [PII] does have an active policy.
[AGENT][NEUTRAL] And the effective date of her policy is [PII].
[CUSTOMER][NEUTRAL] And the effective date of her policy.
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] And this is just to verify benefits. It's not a guarantee of payment.
[CUSTOMER][NEUTRAL] And this is just to verify benefits it's not a guarantee of payment.
[AGENT][NEUTRAL] This is a supplemental insurance policy.
[CUSTOMER][NEUTRAL] This is a supplemental insurance policy.
[AGENT][POSITIVE] It helps with deductible, co-pay, and co-insurance.
[AGENT][NEUTRAL] She has an inpatient benefit amount per occurrence of $2000.
[AGENT][NEUTRAL] And then she also has an outpatient benefit amount per calendar day of $750.
[CUSTOMER][NEUTRAL] Oh, per day.
[CUSTOMER][NEUTRAL] And then would that um cover for the actual specialist um office, is it?
[AGENT][NEUTRAL] Let me look and see if she has office visits on this.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] Alright, I'm looking, I'm gonna need to pull in the policy itself.
[CUSTOMER][NEUTRAL] I'm gonna need
[CUSTOMER][NEUTRAL] Mhm OK.
[AGENT][NEUTRAL] Give me just a second.
[CUSTOMER][POSITIVE] No problem.
[AGENT][NEUTRAL] Uh, office visits are not covered under this policy.
[CUSTOMER][NEUTRAL] Uh
[CUSTOMER][NEUTRAL] OK, so under that, um, 750, the outpatient per day with that, um.
[CUSTOMER][NEUTRAL] Cover for like the allergies, skin testing, the injections, and the serum for the patient?
[AGENT][NEUTRAL] Right, so it will help with the treatment in the outpatient facility, but it does not cover the office visit for the physician.
[CUSTOMER][NEUTRAL] OK, alrighty and then let me give you the other information for the other patient.
[AGENT][NEUTRAL] OK, let me put my notes in this one.
[CUSTOMER][NEUTRAL] And with the um.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] And then we'll move on to the next one.
[CUSTOMER][NEUTRAL] OK, and then would the reference number be the same for the whole call?
[AGENT][NEUTRAL] It will be, yes, ma'am.
[CUSTOMER][NEUTRAL] It
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Mm
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] And what is the next patient's name, date of birth, and policy number?
[CUSTOMER][NEUTRAL] A member's name is [PII]. Date of birth is [PII]. Member's ID is 02415368. M as in Mike, L as in Lima, 8.
[AGENT][NEUTRAL] OK, let me pull that one up real quick.
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] Mm.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] OK, [PII] does have an active policy. The effective date of the policy is [PII].
[AGENT][NEUTRAL] And this is to verify benefits. It's not a guarantee of payment. She has the same type of policy as it's a supplemental policy that helps with deductible, co-pay and co-insurance.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] And
[AGENT][NEUTRAL] They have an inpatient calendar year benefit amount of $7500 and then an outpatient calendar year benefit amount of $7500 also.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] And then has she met anything towards that um outpatient benefit?
[AGENT][NEUTRAL] OK, and you wanted to check to see if office visits were available on this policy too?
[CUSTOMER][NEUTRAL] Um, yes.
[AGENT][NEUTRAL] OK, let me pull up their policy real quick so I can review it.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] No, ma'am, office visits are not covered under this patient's policy.
[CUSTOMER][POSITIVE] OK perfect.
[CUSTOMER][NEUTRAL] Alrighty and then the that outpatient um benefit would apply towards the um allergy.
[CUSTOMER][NEUTRAL] Um, testing and treatment.
[AGENT][NEUTRAL] treatment in the office but not the physician's fee.
[CUSTOMER][NEUTRAL] Treat
[CUSTOMER][NEUTRAL] Yes, OK.
[CUSTOMER][NEUTRAL] Alrighty and then um [PII] if I can just go ahead and just get the first initial to your last name and then just a reference number for the call and then that'll be it.
[AGENT][NEUTRAL] Yes, yes, ma'am. You can use my name [PII] and my last initial is [PII]
[AGENT][NEUTRAL] And today's date for your reference number.
[CUSTOMER][POSITIVE] Mhm. OK, alrighty, Tor, thank you so much.
[AGENT][POSITIVE] You're very welcome, [PII]. Thank you for calling APL. I hope you have a wonderful day.
[CUSTOMER][POSITIVE] You're very welcome
[CUSTOMER][POSITIVE] You as well thank you bye bye.
[AGENT][NEUTRAL] Mhm. Bye-bye.