AccountId: 011433970860
ContactId: ae7065c9-bf7e-419e-b981-70b78052c8ab
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 220600 ms
Total Talk Time (AGENT): 113736 ms
Total Talk Time (CUSTOMER): 57460 ms
Interruptions: 0
Overall Sentiment: AGENT=2.5, CUSTOMER=0.3
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/01/17/ae7065c9-bf7e-419e-b981-70b78052c8ab_20250117T20:46_UTC.wav
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[AGENT][POSITIVE] Afternoon, thank you for calling APL. My name is [PII]. How may I help you?
[CUSTOMER][NEUTRAL] Uh, yes, I'm calling for benefits and eligibility for a patient.
[AGENT][POSITIVE] It would be my pleasure to assist you this afternoon with benefits and eligibility. What is your name?
[CUSTOMER][NEUTRAL] It's [PII].
[AGENT][POSITIVE] Thank you, [PII] and what is a good callback number?
[CUSTOMER][NEUTRAL] It would be [PII].
[AGENT][NEUTRAL] Thank you, [PII], and what is the policy number for the patient?
[CUSTOMER][NEUTRAL] Um, I have 021.
[CUSTOMER][NEUTRAL] 35061
[AGENT][NEUTRAL] Thank you, [PII] and what is the patient's name and date of birth, please, ma'am?
[CUSTOMER][NEUTRAL] Um, it's for [PII], and it's [PII].
[AGENT][POSITIVE] All right, thank you.
[AGENT][POSITIVE] And it would be my pleasure to assist you with eligibility and benefits for Ms. [PII]. I am showing that her policy is active.
[AGENT][NEUTRAL] Effective date is [PII]. This is a secondary policy to her major.
[AGENT][POSITIVE] Sorry about that. Let me try that again. Major medical coverage?
[AGENT][NEUTRAL] And what type of benefits are you needing?
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Um, uh, it's like for a specialist office visit and outpatient surgery.
[AGENT][NEUTRAL] OK, so for the office visit copay, there are no benefits on her APL policy to cover the office visit copay. She does have benefits for treatments or procedures performed in a doctor's office.
[AGENT][NEGATIVE] But not for the visit.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK
[AGENT][NEUTRAL] And
[AGENT][NEUTRAL] The procedures and treatments in office along with their outpatient benefit, it's all covered under her outpatient coverage of $6000 per calendar year.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] That is a verification of coverage, not a guarantee of payment?
[AGENT][NEUTRAL] And on this policy, [PII], she does have a $100 deductible.
[AGENT][NEUTRAL] That she has to meet before the $6000 is paid out.
[CUSTOMER][NEUTRAL] OK
[CUSTOMER][NEUTRAL] I mean y'all will pay like 100% up to the $6000 max, correct?
[AGENT][NEUTRAL] That's correct to her deductible co-pay or co-insurance of the major medical.
[CUSTOMER][NEUTRAL] OK
[CUSTOMER][NEUTRAL] And um there's no pre-certs uh with y'all correct?
[AGENT][NEUTRAL] That is correct. We do follow the guidelines of the major medical.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] And I believe that is all I needed then for now. Um, do you do reference number?
[AGENT][NEUTRAL] It would be my name in today's date, and I spell my name [PII].
[AGENT][POSITIVE] [PII], it was a pleasure to assist you with those benefits. You sure there's nothing else I can help you with?
[CUSTOMER][NEUTRAL] Um, no, that's all I needed.
[AGENT][POSITIVE] Well thank you for calling APL. I hope you have a wonderful afternoon and a happy weekend.
[CUSTOMER][POSITIVE] Thank you, same to you.
[AGENT][POSITIVE] Thank you, [PII]. Bye bye.
[CUSTOMER][NEUTRAL] Bye.