AccountId: 011433970860
ContactId: afd7b5ff-caf9-4964-a7fe-6c02e29d59ae
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 185199 ms
Total Talk Time (AGENT): 89057 ms
Total Talk Time (CUSTOMER): 63687 ms
Interruptions: 0
Overall Sentiment: AGENT=1, CUSTOMER=0.7
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/01/29/afd7b5ff-caf9-4964-a7fe-6c02e29d59ae_20250129T18:58_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]. My name is [PII]. My last initial is [PII]. I'm calling from a facility to verify um benefits eligibility for a mutual patient.
[AGENT][POSITIVE] Yes, I can check benefits and eligibility for you. Uh, [PII], can I get a good call back number from you first in case we're disconnected?
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Sure, it's [PII].
[AGENT][NEUTRAL] Mhm.
[AGENT][NEUTRAL] Got it, thank you. Do you have the policy number?
[CUSTOMER][NEUTRAL] Yeah, sure, one moment.
[CUSTOMER][NEUTRAL] Policy number is 01343212 MLB.
[AGENT][NEUTRAL] OK, thank you. And what was the name and date of birth for the member?
[CUSTOMER][NEUTRAL] Um, [PII]
[CUSTOMER][NEUTRAL] And date of birth is [PII].
[AGENT][NEUTRAL] Perfect, thank you for verifying that [PII]. Uh, so this 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, and we're gonna need to check the outpatient benefits.
[CUSTOMER][NEUTRAL] Um, uh, correct, uh, for you need a CPT code or?
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] Uh, no, um, let's see, is it, um.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] They're just gonna be receiving treatment? Oh, radiology, OK, um, and what kind of facility?
[CUSTOMER][NEUTRAL] Radilogy.
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] 00, free standing.
[AGENT][NEUTRAL] OK, uh, let's take a look here.
[AGENT][NEUTRAL] So of course I will let you know verification of coverage is not a guarantee of payment for claims. Uh, the outpatient benefit is $1500 max per calendar year. If you'll give me one moment, I will see if any of that has been used.
[AGENT][NEUTRAL] OK, none has been used so far this year.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK, uh, and it covers primary outpatient.
[AGENT][NEUTRAL] As long as the primary is willing to pay, um, then this policy can, this policy is very dependent on the primary. If they do not pay, this policy can't.
[CUSTOMER][NEUTRAL] Yes.
[CUSTOMER][NEUTRAL] Oh, OK, yeah, of course, yes. OK, and what could you spell your first name for me?
[AGENT][NEUTRAL] Yes.
[AGENT][NEUTRAL] Yeah, it's [PII].
[CUSTOMER][NEUTRAL] And your last initial?
[AGENT][NEUTRAL] A
[CUSTOMER][NEUTRAL] Hey, I don't need to call reference or anything, do I?
[AGENT][NEUTRAL] Uh, it would just be my first name, last initial, and then today's date. Was there anything else I could help you with, [PII]?
[CUSTOMER][POSITIVE] OK, perfect.
[CUSTOMER][POSITIVE] No, that's it. Thank you very much.
[AGENT][POSITIVE] Alright, yeah, thanks for calling APL. I hope you have a great rest of your day.
[CUSTOMER][NEUTRAL] You too bye bye.
[AGENT][POSITIVE] Thank you, bye bye.