AccountId: 011433970860
ContactId: a825faaa-270b-4874-9d79-f1f8a13207b8
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 397790 ms
Total Talk Time (AGENT): 174301 ms
Total Talk Time (CUSTOMER): 181454 ms
Interruptions: 3
Overall Sentiment: AGENT=1, CUSTOMER=0.8
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/03/24/a825faaa-270b-4874-9d79-f1f8a13207b8_20250324T19:43_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] Hello, my name is [PII] and the initial of my last name is [PII].
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] I'm just calling to know the benefits for a middle patient.
[AGENT][POSITIVE] It would be my pleasure to assist you, [PII]. What is a good callback number?
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] Thank you, [PII]. And the policy number for the patient, please?
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] Um.
[CUSTOMER][NEUTRAL] 60801.
[AGENT][NEUTRAL] That is actually our payer ID. Do you have the policy certificate or if you're looking at the card, it could be at the bottom of the card under outpatient benefit cert number.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] I
[CUSTOMER][NEUTRAL] Yes, um, I have the card here and I'm seeing a number outpatient benefit cert number.
[AGENT][NEUTRAL] Yes, sir. That's it. Yes, sir.
[CUSTOMER][NEUTRAL] Maybe it works, OK, 02270266.
[AGENT][NEUTRAL] Mm
[CUSTOMER][NEUTRAL] M as in Michael, L as in Lima, 8.
[AGENT][NEUTRAL] Thank you. And [PII], what is the patient's name and date of birth, please?
[CUSTOMER][NEUTRAL] Yeah
[CUSTOMER][NEUTRAL] Patient's name is [PII] and the last name is [PII].
[AGENT][NEUTRAL] And date of birth?
[CUSTOMER][NEUTRAL] I
[CUSTOMER][NEUTRAL] Um, [PII].
[AGENT][POSITIVE] All right, thank you.
[CUSTOMER][NEUTRAL] Uh
[AGENT][NEUTRAL] And you, it would be my pleasure to assist you with eligibility and benefits for [PII]. Now, actually, [PII], the policy number that you gave me is no longer active. This policy turned on 11-1-2024.
[CUSTOMER][POSITIVE] Thank
[AGENT][NEUTRAL] However, she does have coverage under a another policy number. Can I give you her active policy information?
[CUSTOMER][POSITIVE] Of course, yes, thanks.
[AGENT][POSITIVE] My pleasure. As of [PII], her active policy number is 256.
[AGENT][NEUTRAL] 4532
[CUSTOMER][NEUTRAL] That's her policy number.
[AGENT][POSITIVE] That's correct, and it is active.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Uh
[CUSTOMER][NEUTRAL] Uh, OK, so.
[AGENT][NEUTRAL] And you would
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] I want to know uh if you have.
[CUSTOMER][NEUTRAL] Uh, some kind of benefits for this patient. Uh, for me, the most important are to know if you maybe cover the woman test and the IUD and the preventive services.
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] And also maybe if you have benefits for X-rays, surgery, or specialist office.
[AGENT][NEUTRAL] And I can help you with those benefits. Now, [PII], for wellness or screening or IUD, it is not covered under the plan.
[CUSTOMER][NEUTRAL] No
[AGENT][NEUTRAL] This policy pays towards sickness or injury.
[CUSTOMER][NEUTRAL] Yeah
[AGENT][NEUTRAL] And for the office visit, if she comes in for a sick office visit, the office visit co-pay is not covered.
[AGENT][NEUTRAL] However, she does have the office treatment rider, which could provide benefits for any procedures or treatments in a doctor's office for sickness or injury.
[CUSTOMER][NEUTRAL] OK.
[AGENT][POSITIVE] And I can provide that benefit amount if needed.
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] Uh, the amount for what?
[AGENT][NEUTRAL] If she comes in for any procedures or treatments in office for a sickness or injury, this policy does provide benefits for that.
[CUSTOMER][NEUTRAL] Um
[CUSTOMER][NEUTRAL] OK, for surgery, but just in an emer emergency, right?
[AGENT][NEUTRAL] Or if, as long as it is for a sickness or injury diagnosis code.
[CUSTOMER][NEUTRAL] I uh.
[AGENT][NEUTRAL] It could be considered for benefits and then that would be in a doctor's office or in an outpatient hospital facility.
[CUSTOMER][NEUTRAL] Ah, OK, that's for injuries only.
[AGENT][NEUTRAL] Or sickness diagnosis.
[CUSTOMER][NEUTRAL] OK, but for surgery is not covered neither, right?
[AGENT][NEUTRAL] Surgery for a sickness or an injury is covered.
[CUSTOMER][NEUTRAL] Yeah
[CUSTOMER][NEUTRAL] OK, give me.
[AGENT][NEUTRAL] And it can be covered in a doctor's office or in an outpatient facility as well, or inpatient hospital.
[CUSTOMER][NEUTRAL] Oh, OK, thank you, give me just one second please, I hung up.
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] The pizza.
[CUSTOMER][NEUTRAL] I.
[CUSTOMER][NEUTRAL] Hi
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] Yeah
[CUSTOMER][POSITIVE] OK, thank you so much for holding and and this patient doesn't have any an all deductible or individual deductible or out of pocket with you, right?
[AGENT][NEUTRAL] Not on this policy. We are secondary to the policyholder's major medical insurance.
[CUSTOMER][POSITIVE] OK, thank you so much. Now, may I have your name and the reference number for this call and that's it, please?
[AGENT][NEUTRAL] My name is [PII]
[AGENT][NEUTRAL] First initial last name, [PII].
[AGENT][NEUTRAL] Reference number is my name and today's date.
[CUSTOMER][NEUTRAL] Oh yeah.
[CUSTOMER][POSITIVE] OK [PII] you were very helpful have a nice day.
[AGENT][POSITIVE] [PII], it was my pleasure to help you with those benefits for [PII]. Great. Thank you for calling APL and I hope you have a wonderful day as well. Take care.
[CUSTOMER][POSITIVE] Just uh thanks.
[AGENT][NEUTRAL] Mm bye-bye.
[CUSTOMER][NEUTRAL] Bye.
[CUSTOMER][NEUTRAL] Yeah