AccountId: 011433970860
ContactId: aa0e1a40-21bd-48f7-8603-bf430f7de38f
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 326519 ms
Total Talk Time (AGENT): 119676 ms
Total Talk Time (CUSTOMER): 115491 ms
Interruptions: 0
Overall Sentiment: AGENT=1.1, CUSTOMER=0.8
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/01/28/aa0e1a40-21bd-48f7-8603-bf430f7de38f_20250128T18:32_UTC.wav
--------------------------------------------
[AGENT][NEUTRAL] Thank you for calling American Public Life. This is [PII]. How may I assist you?
[AGENT][POSITIVE] Thank you for calling American Public Life.
[AGENT][NEUTRAL] How may I assist you?
[CUSTOMER][NEUTRAL] Hi, yes, hi, I'm calling for benefits and eligibility please for one of our patients.
[AGENT][NEUTRAL] May I have your name and a callback number?
[CUSTOMER][NEUTRAL] [PII] and it's [PII].
[CUSTOMER][NEUTRAL] I just
[AGENT][NEUTRAL] And that was [PII]?
[CUSTOMER][NEUTRAL] [PII]
[AGENT][NEUTRAL] And may I please have the policy number?
[CUSTOMER][NEUTRAL] I have 962-8887.
[CUSTOMER][NEUTRAL] No.
[AGENT][NEUTRAL] May I have the patient's name and date of birth?
[CUSTOMER][NEUTRAL] It's gonna be from um [PII] The last name is [PII]
[CUSTOMER][NEUTRAL] The date of birth of the patient is [PII].
[AGENT][POSITIVE] And thank you so much [PII] for verifying the policy. How may I assist you?
[CUSTOMER][NEUTRAL] I'm calling for benefits eligibility please for an office visit and outpatient surgery.
[AGENT][NEUTRAL] OK, so you're needing the office visit benefit and the outpatient rental in an outpatient facility?
[CUSTOMER][NEUTRAL] Yes, no, it's gonna be done in the specialist office setting, sorry.
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] I see.
[AGENT][POSITIVE] Thank you.
[AGENT][NEUTRAL] I'm pulling that information up for you now.
[CUSTOMER][POSITIVE] OK, thank you.
[AGENT][POSITIVE] You're welcome.
[AGENT][NEUTRAL] And verification of coverage does not guarantee the payment of the claim for this policy, it shows that the member is currently active. The effective date is [PII].
[AGENT][NEUTRAL] And for services rendered within an office setting, the member does have up to.
[AGENT][NEUTRAL] $25 per visit with a maximum of 4 visits per calendar year. Is there anything else that I can assist you with today, [PII]?
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] It's $25 per visit for visits for office visit.
[AGENT][POSITIVE] That is correct.
[AGENT][POSITIVE] That is correct.
[CUSTOMER][NEUTRAL] OK, um.
[CUSTOMER][NEUTRAL] 25.
[CUSTOMER][NEUTRAL] Other copay.
[CUSTOMER][NEUTRAL] 4 visits, how much has been accumulating? You.
[AGENT][NEUTRAL] Let me check that for you.
[CUSTOMER][POSITIVE] Thank you so much.
[AGENT][POSITIVE] You're welcome.
[AGENT][NEGATIVE] As of right now, the member has not used any of their benefits.
[CUSTOMER][POSITIVE] Alrighty perfect and for the outpatient.
[AGENT][NEUTRAL] Is this rendered within an outpatient facility?
[CUSTOMER][NEUTRAL] It's gonna be done in the specialist office setting.
[AGENT][NEUTRAL] That will be up on the, the office that I just gave you.
[CUSTOMER][NEUTRAL] Yes, specialist office.
[AGENT][NEUTRAL] Correct. Yeah, they don't have, if it's outpatient, it is rendered within an outpatient facility.
[CUSTOMER][NEUTRAL] Mm.
[CUSTOMER][NEUTRAL] No
[CUSTOMER][NEUTRAL] OK, so they only cover office visit not outpatient?
[AGENT][NEUTRAL] If, if anything rendered within an office setting, that is the benefit that I just gave you. If you're asking for outpatient benefits that is rendered within an outpatient facility.
[CUSTOMER][NEUTRAL] Bye.
[CUSTOMER][NEUTRAL] I
[AGENT][NEUTRAL] Not in.
[CUSTOMER][NEUTRAL] OK perfect um yeah uh for outpatient facility, how much would you guys pay up to?
[AGENT][NEUTRAL] If it's rented within an outpatient facility, the member has up to $3000 per calendar year.
[CUSTOMER][NEUTRAL] $3000 per calendar year and how much has been accumulated?
[AGENT][NEUTRAL] The member has not used any of their benefits for this year.
[CUSTOMER][MIXED] OK, but the office visit still stays the same, the $25 the plan pays up to $25 for 4 visits, correct?
[AGENT][NEUTRAL] Up to 4
[AGENT][NEUTRAL] Yes.
[CUSTOMER][POSITIVE] OK, perfect. Alrighty and your name is?
[AGENT][NEUTRAL] It is [PII]. Would you like me to spell that for you?
[CUSTOMER][NEUTRAL] Please.
[AGENT][NEUTRAL] It is spelled [PII] Last [PII] and today's date will be used as the call reference.
[CUSTOMER][POSITIVE] Thank you so much. You have a great rest of your day, OK?
[AGENT][POSITIVE] You're welcome. Thank you for calling American Public Life. You have a great day as well.
[CUSTOMER][NEUTRAL] Mm.
[CUSTOMER][NEUTRAL] Bye.
[AGENT][NEUTRAL] Bye.