AccountId: 011433970860
ContactId: ad542afb-0090-4051-b935-e99e7526d1c7
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 140779 ms
Total Talk Time (AGENT): 64316 ms
Total Talk Time (CUSTOMER): 67940 ms
Interruptions: 0
Overall Sentiment: AGENT=1.8, CUSTOMER=0.5
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/06/04/ad542afb-0090-4051-b935-e99e7526d1c7_20250604T13:58_UTC.wav
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[AGENT][NEUTRAL] Calling APL, this is [PII]. How may I assist you? Excuse me. How may I assist you?
[CUSTOMER][NEUTRAL] Good good morning. This is [PII]. I'm calling from Doctor [PII]'s office, and I'm trying to confirm benefits for a member, please.
[AGENT][NEUTRAL] Sure [PII], I can assist you with that. Can I have a callback number for you and that policy number?
[CUSTOMER][NEUTRAL] [PII]
[AGENT][NEUTRAL] Thank you and what's the policy number?
[CUSTOMER][NEUTRAL] And I'm sorry, what else did you ask for? Oh, the policy number is 02586617.
[AGENT][NEUTRAL] Could you verify that patient's name and date of birth?
[CUSTOMER][NEUTRAL] uh [PII] [PII].
[AGENT][NEUTRAL] And [PII], you're calling to verify benefits for what type of services is it inpatient, outpatient, office visits?
[CUSTOMER][NEUTRAL] Office specialist office visit and um ultrasound being done at the office uh so I need to know if this policy will cover him for the office visit copayment or for the ultrasound um insurance deductible.
[AGENT][NEUTRAL] This policy has been active since [PII] and it's currently active and the member has outpatient, mm, I'm sorry, the member has physician office visit up to $25 per visit with 5 visits per 4 visits per calendar year, and this is not a guarantee of benefits just a disclaimer of the policy's coverage.
[AGENT][NEUTRAL] However, if it's considered as outpatient, it'd be $500 per occurrence, and this is not a guaranteed benefits, just a disclaimer of the policy's coverage, and he has not utilized any of his benefits for 2025.
[CUSTOMER][NEUTRAL] OK, so for the office visit, um, you cover up to 25 per visit, even for a specialist.
[AGENT][POSITIVE] Yes, that is correct.
[AGENT][POSITIVE] Yes, that's correct.
[CUSTOMER][NEUTRAL] OK, and then the ultrasound would be under the 500 per um current?
[AGENT][NEUTRAL] If it's considered as outpatient.
[CUSTOMER][NEUTRAL] OK, up to $500. Alright, and can I please have your mailing address for claims? So let me just confirm the one in the card, the [PII].
[AGENT][POSITIVE] [PII], yes, that is correct.
[CUSTOMER][NEUTRAL] Got it. OK, and remind me your name, honey?
[AGENT][NEUTRAL] My name is [PII] and today's date as a reference.
[CUSTOMER][NEUTRAL] Hm
[CUSTOMER][POSITIVE] Thank you very much for your help appreciate it. Have a good day bye bye.
[AGENT][POSITIVE] You're welcome, thanks for calling APL and have a great day.