AccountId: 011433970860
ContactId: a974e1f4-3967-4480-8082-0dccc5cbe461
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 234199 ms
Total Talk Time (AGENT): 102577 ms
Total Talk Time (CUSTOMER): 48554 ms
Interruptions: 0
Overall Sentiment: AGENT=1.7, CUSTOMER=0.5
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/01/13/a974e1f4-3967-4480-8082-0dccc5cbe461_20250113T16:06_UTC.wav
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[AGENT][NEUTRAL] Hi, thank you for calling APL. This is [PII]. How can I help you today?
[CUSTOMER][NEUTRAL] Hi, yes, hi, [PII]. Good morning. My name is [PII]. I'm calling to check benefits and eligibility on a member, please.
[AGENT][POSITIVE] OK, yeah, I'd love to help you with some eligibility and benefits today, Ms. [PII], and do you mind if I get a good call back number from you?
[CUSTOMER][NEUTRAL] Uh, that is [PII].
[AGENT][NEUTRAL] Mm
[AGENT][NEUTRAL] Thank you and your member's policy number?
[CUSTOMER][NEUTRAL] Um, give me one second. That is 023 04128.
[AGENT][POSITIVE] Perfect and give me just a moment to get that uh member pulled up.
[CUSTOMER][POSITIVE] Perfect
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] Right.
[AGENT][NEUTRAL] Perfect. And can you verify for me, pretty please, your patient's first and last name and date of birth?
[CUSTOMER][NEUTRAL] [PII] and um date of birth is [PII].
[AGENT][POSITIVE] Wonderful thank you so much and you said you're looking for eligibility and benefits, is that correct?
[CUSTOMER][NEUTRAL] Yes.
[AGENT][NEUTRAL] Alright, perfect. Um, your patient is current and active. She has an effective date of [PII]. She also has an updated policy number. Can I give that to you?
[CUSTOMER][NEUTRAL] Uh, yes.
[AGENT][POSITIVE] Perfect. Let me know when you're ready, my friend.
[CUSTOMER][NEUTRAL] Go ahead.
[AGENT][POSITIVE] Perfect. Her policy number is 25834777.
[AGENT][NEUTRAL] And then for benefits are we looking for inpatient or outpatient?
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK
[CUSTOMER][NEUTRAL] Um, that will be for, um, outpatients.
[AGENT][NEUTRAL] Outpatient, perfect. Alright, I do want to let you know that any benefit information I give you over the phone is a verification of coverage and not a guaranteed payment.
[AGENT][NEUTRAL] It looks like on her policy.
[AGENT][NEUTRAL] Um, hold on, I've never seen this.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] Oh, OK, I'm sorry, she has a combined, um, that's why it looked like that so she has a combined inpatient and outpatient maximum of $5000 per calendar year.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] And how much has been used?
[AGENT][POSITIVE] Yeah, that's a wonderful question. Let's take a look, um.
[AGENT][NEUTRAL] OK
[AGENT][NEUTRAL] I'm not showing that we have anything submitted for the [PII] calendar year yet.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK, that is no problem. And you said your name was [PII].
[AGENT][NEUTRAL] Correct, yes, [PII].
[CUSTOMER][NEUTRAL] And can you provide a reference number for today's call?
[AGENT][NEUTRAL] Yeah, it's just gonna be my first name [PII], my last initial B, and today's date.
[CUSTOMER][POSITIVE] Got it. Perfect. Thank you so much for your help, [PII].
[AGENT][POSITIVE] Hey, it's my pleasure, Ms. [PII]. Thank you for calling [PII]. You have a wonderful day.
[CUSTOMER][NEUTRAL] You too, bye-bye.
[AGENT][NEUTRAL] Bye bye.