AccountId: 011433970860
ContactId: ad8074e3-1672-4196-9951-51a49b51d362
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 214630 ms
Total Talk Time (AGENT): 113883 ms
Total Talk Time (CUSTOMER): 56230 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/2025/02/05/ad8074e3-1672-4196-9951-51a49b51d362_20250205T19:22_UTC.wav
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[AGENT][NEUTRAL] Thank you for calling APL. This is [PII]. How can I help you?
[CUSTOMER][NEUTRAL] Hi [PII], this is [PII] calling from University of Miami Hospital. I'm calling to check what are the benefits that the patient has available for an X-ray on a hospital-based facility. How do you spell your name?
[AGENT][NEUTRAL] It's [PII] and I'm sorry, you said that was for um an X-ray in a hospital facility?
[CUSTOMER][POSITIVE] Correct.
[AGENT][NEUTRAL] OK and um what did you say your name was? I'm sorry.
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] Could you spell that for me?
[CUSTOMER][NEUTRAL] [PII]
[AGENT][POSITIVE] OK, thank you and [PII], can I get a good call back number from you in case we're disconnected please?
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] All right, thank you. And do you have that policy number?
[CUSTOMER][NEUTRAL] The policy number that I have is um
[CUSTOMER][NEUTRAL] 022
[CUSTOMER][NEUTRAL] 84025.
[AGENT][NEUTRAL] OK, thank you and then what was the name and date of birth for the insured?
[CUSTOMER][NEUTRAL] [PII].
[CUSTOMER][NEUTRAL] On [PII].
[AGENT][NEUTRAL] OK, perfect. Thank you for verifying that [PII]. Uh, so the policy is active. Effective date was [PII], and this is a secondary medical policy, so it is designed to help with co-pay, deductible and co-insurance after major medical pays. If you bear with me one moment, let me see that, uh.
[AGENT][NEUTRAL] Make sure that that benefit is covered.
[AGENT][NEUTRAL] It's just a hospital outpatient facility, is that correct?
[CUSTOMER][NEUTRAL] No, a specialist office space. It's for a specialist.
[AGENT][NEUTRAL] Oh, specialist. Oh, OK.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] Alright, and of course I will let you know verification of coverage is not a guarantee of payment for claims, um, so while office visits are not covered under this policy, treatment in office is, so that would fall under their outpatient benefit which is $2500 max per calendar year and I know we're still kind of at the beginning of the month or the year but I'll go ahead and see if any of that has been used.
[AGENT][NEUTRAL] OK, none has been used so far this year.
[CUSTOMER][NEUTRAL] OK. So the X-ray from a hospital-based facility?
[CUSTOMER][NEUTRAL] It's not covered?
[AGENT][NEUTRAL] I'm sorry, did you, was it a hospital or a, um, specialist office?
[CUSTOMER][NEUTRAL] A specialist's office, but she's having an X-ray on a specialist's office.
[AGENT][NEUTRAL] Yes, the treatment in office is covered. The visits themselves are not, if that makes sense.
[CUSTOMER][POSITIVE] OK, perfect.
[CUSTOMER][NEUTRAL] OK. Yes, he's gonna be having an X-ray plus the visit. So yes, it will be the same.
[AGENT][NEUTRAL] OK, OK.
[AGENT][POSITIVE] Got you, yes, perfect OK.
[CUSTOMER][NEUTRAL] OK, perfect. Do you, um, do you have like a reference and a reference number for the call?
[AGENT][NEUTRAL] Uh, did you have any other questions for me?
[AGENT][NEUTRAL] Reference would just be my first name, last initial, and today's date. Uh, so my name is spelled [PII] last [PII]
[CUSTOMER][POSITIVE] OK perfect thank you.
[AGENT][POSITIVE] Yeah, thanks for calling APL. I hope you have a great rest of your day.
[CUSTOMER][NEUTRAL] You too.
[AGENT][POSITIVE] Thank you. Bye-bye.