AccountId: 011433970860
ContactId: b8524a87-67e7-4a23-84e2-c48997ab9e4b
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 345029 ms
Total Talk Time (AGENT): 121633 ms
Total Talk Time (CUSTOMER): 87413 ms
Interruptions: 0
Overall Sentiment: AGENT=0.8, CUSTOMER=1
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/03/13/b8524a87-67e7-4a23-84e2-c48997ab9e4b_20250313T16:45_UTC.wav
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[AGENT][NEUTRAL] Thank you for calling APL. This is [PII]. How may I help you?
[CUSTOMER][NEUTRAL] Hi, good afternoon. My name is [PII]. I'm calling from urology specialty care. I just wanted to get some benefits for a patient.
[AGENT][NEUTRAL] OK, I can help with benefits. Um, can I please get your callback number, Miss [PII]?
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] Thank you. And then what is the patient's name, date of birth, and policy number?
[CUSTOMER][NEUTRAL] Yes, it is [PII] [PII].
[CUSTOMER][NEUTRAL] And the policy number is 002216489ML8.
[AGENT][NEUTRAL] OK, let me look that up real quick.
[AGENT][POSITIVE] OK, I do see that [PII] does have an active policy with us.
[AGENT][NEUTRAL] And let me let you know his effective date here just a second it's to pull it in for us.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] His effective date is [PII].
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] And this is just to verify the benefits. It's not a guarantee of payment. He has a supplemental insurance policy that's billed secondary to the primary. It's a gap insurance that helps with deductible, co-pay, and co-insurance.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] He has a
[CUSTOMER][NEUTRAL] So it covers.
[AGENT][NEUTRAL] Uh-huh. Go ahead.
[CUSTOMER][NEUTRAL] It covers copays you said?
[AGENT][NEUTRAL] Yes, deductible, co-pay, and coinsurance.
[CUSTOMER][NEUTRAL] Mm
[AGENT][NEUTRAL] And he has a uh inpatient calendar year benefit amount of $1000 and then he also has an outpatient calendar day benefit amount of $200.
[CUSTOMER][NEUTRAL] So it only covers $200 a day.
[AGENT][NEUTRAL] Yes.
[CUSTOMER][NEUTRAL] For outpatient procedures done in an office?
[AGENT][NEUTRAL] Yeah.
[AGENT][NEUTRAL] For yes, well, let me make sure he has office visits. Let me check on that for you.
[AGENT][NEUTRAL] It's gonna pull in the policy for me so it's gonna be just a minute while it loads.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] Uh, Una May Nicole.
[AGENT][POSITIVE] Oh, it's taking a little time. I'm sorry.
[CUSTOMER][NEUTRAL] No, so
[CUSTOMER][NEUTRAL] It's a lot. This call I see the emergency for the PA chat.
[CUSTOMER][NEUTRAL] Oh where's Mandela's class in in that sort of uh like something.
[AGENT][NEUTRAL] OK, this policy does not cover office visits for the physician.
[CUSTOMER][NEUTRAL] So it doesn't cover office visits?
[AGENT][POSITIVE] Correct.
[CUSTOMER][NEUTRAL] Because you had said copays.
[CUSTOMER][NEUTRAL] OK, just making sure.
[AGENT][NEUTRAL] Right, it helps with co-pay, deductible or co-insurance.
[AGENT][NEUTRAL] In a um covered facility and office visits are not a covered facility.
[CUSTOMER][NEUTRAL] OK, alright, perfect, uh, coverage procedures and just coverage procedures.
[CUSTOMER][NEUTRAL] Alright, perfect. Can I get your, your name once again and a reference number?
[AGENT][NEUTRAL] Yes, you, my name is [PII] and you can use my name and today's date for your reference.
[CUSTOMER][NEUTRAL] So
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] Is there anything else I can help you with before we go, Ms. [PII]?
[CUSTOMER][POSITIVE] Alright perfect.
[CUSTOMER][POSITIVE] No that was all thank you so much for your help.
[AGENT][POSITIVE] You're very welcome. I hope you have a wonderful day and calling APL.
[CUSTOMER][POSITIVE] You as well thank you bye bye.
[AGENT][NEUTRAL] Bye-bye, ma'am.