AccountId: 011433970860
ContactId: af88f817-fb09-4dfe-9eb0-f8faa0ea62ac
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 141369 ms
Total Talk Time (AGENT): 90128 ms
Total Talk Time (CUSTOMER): 34998 ms
Interruptions: 0
Overall Sentiment: AGENT=1.4, CUSTOMER=1.5
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/02/25/af88f817-fb09-4dfe-9eb0-f8faa0ea62ac_20250225T14:01_UTC.wav
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[AGENT][NEUTRAL] Good Morning. Thank you for calling APL. This is [PII]. How may I help you today?
[CUSTOMER][NEUTRAL] Hi, good morning. I'm calling from the Midtown Women's Center to um get outpatient benefits for a member.
[AGENT][POSITIVE] Yes, ma'am. I'll be glad to help you. Go ahead and give me a good policy number and your name, please, ma'am.
[CUSTOMER][NEUTRAL] My name is [PII] and the policy number is 01991166 M as in Mike L as in Larry 8.
[AGENT][POSITIVE] All right, [PII], thank you so much for all that information. Now while I'm pulling this up, go ahead and give me a good return telephone call number, please.
[CUSTOMER][NEUTRAL] [PII]
[AGENT][NEUTRAL] Alrighty, thank you, [PII] for all that information. Now, your patient's name and date of birth today.
[CUSTOMER][NEUTRAL] [PII] and the date of birth is [PII].
[AGENT][NEUTRAL] All right, looks like [PII] is the dependent spouse on this medical supplemental plan. I do show her original effective date is [PII]. She is current and active, but I must advise that verification of coverage is not a guarantee of payment on a claim, but you did say you want outpatient benefits. Is that correct?
[CUSTOMER][NEUTRAL] Yes.
[AGENT][NEUTRAL] All right, let's see. OK, now, of course, what we are is her medical supplemental plan. So the only thing that we will pick up and pay on is anything for sickness and injury that is applied towards her deductible, co-pay or co-insurance at her primary insurance carrier. Nothing routine here is covered no matter what. Her outpatient benefit here is a no pre-cert, no deductible, and a maximum of $5000 payable per calendar year.
[CUSTOMER][NEUTRAL] OK, has she used any of that as of now?
[AGENT][NEUTRAL] Let's see.
[AGENT][NEGATIVE] No, ma'am, as of today, she has not used any of her benefits.
[CUSTOMER][POSITIVE] OK perfect and then can I just have your name again please?
[AGENT][NEUTRAL] Yes, ma'am. My name is [PII] and that is spelled [PII] and is that all that I can help you with today?
[CUSTOMER][POSITIVE] Yeah thank you have a great day.
[AGENT][POSITIVE] You as well, [PII]. Thanks for calling APL. Bye-bye.
[CUSTOMER][NEUTRAL] Bye bye.