AccountId: 011433970860
ContactId: a87ff266-8be9-4297-a8f9-da808ea202aa
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 171380 ms
Total Talk Time (AGENT): 62429 ms
Total Talk Time (CUSTOMER): 61213 ms
Interruptions: 2
Overall Sentiment: AGENT=1.3, CUSTOMER=0.3
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/01/16/a87ff266-8be9-4297-a8f9-da808ea202aa_20250116T21:45_UTC.wav
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[AGENT][NEUTRAL] Good afternoon. Thank you for calling APL. This is [PII]. How can I help you?
[CUSTOMER][NEUTRAL] Yes, hi [PII], I'm calling from Doctor [PII]'s office. I need to go over benefits on a patient, please.
[AGENT][NEUTRAL] OK, you're needing to get benefits. Do you also need eligibility?
[CUSTOMER][NEUTRAL] No, I just need to know if the patient is um has benefits for procedures rendered in the office.
[AGENT][NEUTRAL] OK, yes, ma'am. I can help you with that. And who am I speaking with, please?
[CUSTOMER][NEUTRAL] Yes, hi, my name is [PII]
[AGENT][NEUTRAL] Thank you. And [PII], what is your callback number?
[CUSTOMER][NEUTRAL] Callback number is [PII].
[AGENT][POSITIVE] Thank you. And the member's policy number, please.
[CUSTOMER][NEUTRAL] It is 02255834 ML8.
[AGENT][POSITIVE] Thank you. One moment.
[CUSTOMER][NEUTRAL] One moment.
[AGENT][NEUTRAL] OK, so, um, any information was that I did provide for you will be a verification.
[AGENT][NEUTRAL] of benefits and not a guarantee of payment. What is your patient's name and their date of birth?
[CUSTOMER][NEUTRAL] It's [PII] [PII].
[AGENT][NEUTRAL] OK, thank you. And you said you did not need eligibility, only benefits, is that correct?
[CUSTOMER][NEUTRAL] No, I need to know if he has benefits for procedures rendered in the office.
[AGENT][NEUTRAL] On this supplemental policy, no, ma'am. Treatment done with office visits and treatment within the office are not covered.
[CUSTOMER][NEUTRAL] Let me see, he says that he does have treatment, um, that he, the gap plan does not cover, oh yeah, it does not. The gap plan does not cover procedures in the office. It's only for hospital setting, so he knew about this back in July.
[CUSTOMER][NEUTRAL] OK, so, um, alright, let me have a reference number for the call, thank you.
[AGENT][NEUTRAL] Sure, you would use my name along with today's date and if you all end up filing a claim with us, [PII], we will have to have a copy of the primary insurance EOB as well.
[CUSTOMER][NEUTRAL] What
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] Yes, and what's your name again? I'm sorry.
[AGENT][NEUTRAL] [PII]
[CUSTOMER][NEUTRAL] [PII], I'm sorry, [PII], OK, [PII] in today's date. OK, great, thank you. All right then bye bye thanks.
[AGENT][NEUTRAL] Uh, that's OK.
[AGENT][NEUTRAL] Uh-huh.
[AGENT][POSITIVE] OK, well, you're very welcome. So if that's all I can help you with, have a nice evening. Thank you again for calling APL. Uh-huh. Bye-bye.
[CUSTOMER][POSITIVE] You too thank you right you're welcome bye bye.