AccountId: 011433970860
ContactId: ab493d2e-260b-4917-ad80-517904626525
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 202449 ms
Total Talk Time (AGENT): 115696 ms
Total Talk Time (CUSTOMER): 53233 ms
Interruptions: 0
Overall Sentiment: AGENT=0.5, CUSTOMER=1.5
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/05/02/ab493d2e-260b-4917-ad80-517904626525_20250502T18:32_UTC.wav
--------------------------------------------
[AGENT][NEUTRAL] Thank you for calling APL. This is [PII]. How can I help you?
[CUSTOMER][POSITIVE] You said your name once again I'm sorry?
[AGENT][NEUTRAL] Um, it's [PII], um it's spelled [PII] and my last initial is [PII].
[CUSTOMER][NEUTRAL] Hi [PII], yes, I'm calling from the Han Institute. My name is [PII]. I need to verify benefits for a patient, please.
[AGENT][NEUTRAL] I'm sure, [PII], I can assist you with benefits. Um, first, I'll need a good callback number just in case we're disconnected.
[CUSTOMER][NEUTRAL] Yes, [PII].
[AGENT][NEUTRAL] Thank you. Now I need the policy number, please.
[CUSTOMER][NEUTRAL] Yes, ma'am. It's 02465840 ML 8 at the end.
[AGENT][NEUTRAL] Thank you. Now, please verify the patient's name and date of birth.
[CUSTOMER][NEUTRAL] [PII], [PII].
[AGENT][NEUTRAL] OK, thanks again and just let me advise you that verification of coverage does not guarantee payment of claims. Um, she does have a new policy number.
[CUSTOMER][NEUTRAL] Oh she does OK so what is it?
[AGENT][NEUTRAL] Her new policy number is 016.
[AGENT][NEUTRAL] 59812.
[CUSTOMER][POSITIVE] OK perfect thank you so much.
[AGENT][NEUTRAL] Mhm. No problem. And the effective date on this policy was [PII]. The policy is still active. And is this for inpatient or outpatient benefits or an office visit?
[CUSTOMER][NEUTRAL] I need all three of them. I need to know if office visits are covered and then let me just have the inpatient outpatient please.
[AGENT][NEUTRAL] OK, for inpatient, we cover up to 7900 per calendar year and that's for the co-pay, the co-insurance and deductible after the primary insurance processes the claim and for outpatient services, um, including office treatments, we also cover up to 7900 per calendar year, um, but for like, let's see.
[AGENT][NEUTRAL] Yeah, and for office treatments, we cover up to 7900, the charges that goes towards the co-insurance and the deductible before the office visit. Um, is this for a specialist office visit or a PCP?
[CUSTOMER][NEUTRAL] Yes ma'am.
[AGENT][NEUTRAL] It's a specialist.
[CUSTOMER][NEUTRAL] No specialist
[AGENT][NEUTRAL] OK, for specialist office visits for the co-pay, we cover up to $50 for the co-pay and she gets $4 per calendar year, 4 visits per calendar year.
[CUSTOMER][NEUTRAL] Office visit covered.
[CUSTOMER][NEUTRAL] OK, perfect and has she met anything in her inpatient outpatient?
[CUSTOMER][NEUTRAL] Has she used anything?
[AGENT][NEGATIVE] Uh, no.
[AGENT][NEUTRAL] No, ma'am. She hasn't used any of our benefits this year.
[CUSTOMER][POSITIVE] OK perfect. Alright, thank you [PII] is there a reference number for this call?
[AGENT][NEUTRAL] Yes, ma'am. So the reference number, you can use my name and today's date. Um, is there anything else I can assist you with?
[CUSTOMER][POSITIVE] No, that'll be all thank you I appreciate it.
[AGENT][POSITIVE] OK, thank you, [PII], for calling ATL. You have a great weekend. Mm bye.
[CUSTOMER][NEUTRAL] You too bye bye.
[AGENT][POSITIVE] Thank you.