AccountId: 011433970860
ContactId: ba02aaca-1a5a-4690-8d15-81a701bedf5a
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 563989 ms
Total Talk Time (AGENT): 149161 ms
Total Talk Time (CUSTOMER): 63882 ms
Interruptions: 0
Overall Sentiment: AGENT=0.8, CUSTOMER=0.5
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/04/18/ba02aaca-1a5a-4690-8d15-81a701bedf5a_20250418T15:14_UTC.wav
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[AGENT][NEUTRAL] Thank you for calling APL. This is [PII]. How may I help you?
[CUSTOMER][NEUTRAL] Uh hello, I was calling to get eligibility and benefits please.
[AGENT][NEUTRAL] Yes, of course. Whom am I speaking to?
[CUSTOMER][NEUTRAL] My name's [PII].
[AGENT][NEUTRAL] OK, [PII], do you have the policy number on you?
[CUSTOMER][NEUTRAL] Yes, I have 2550107.
[AGENT][POSITIVE] OK, perfect.
[AGENT][NEUTRAL] OK, and then the patient's first and last name and date of birth, please?
[CUSTOMER][NEUTRAL] [PII], [PII].
[AGENT][NEUTRAL] OK, and then what's a good callback number in case our call gets dropped?
[CUSTOMER][NEUTRAL] [PII]
[AGENT][POSITIVE] OK, perfect.
[AGENT][NEUTRAL] OK, so it looks like the policy is currently active. The effective date is [PII].
[CUSTOMER][POSITIVE] Thank you.
[AGENT][POSITIVE] You're welcome.
[CUSTOMER][NEUTRAL] And could I just have you check benefits, please?
[AGENT][POSITIVE] Yes, of course. What benefits were you?
[AGENT][NEUTRAL] Um, wondering about.
[CUSTOMER][NEUTRAL] Primary care specialists and urgent care. I just need to see if they have any co-pays, please.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] You said primary care, urgent care, and what was the last one?
[CUSTOMER][NEUTRAL] Specialist.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] OK. Let me just put you on a brief hold while I look deeper into this policy, OK?
[CUSTOMER][POSITIVE] OK, thank you.
[AGENT][POSITIVE] OK, thank you.
[CUSTOMER][NEGATIVE] You are on hold.
[AGENT][NEUTRAL] 2
[CUSTOMER][NEGATIVE] You are on hold.
[CUSTOMER][NEGATIVE] You are on hold.
[AGENT][POSITIVE] OK Summer, thank you for holding.
[CUSTOMER][POSITIVE] You're welcome.
[AGENT][NEUTRAL] OK, so for this policy, we do not cover copays, but we do have an outpatient amount. So,
[AGENT][NEUTRAL] For urgent care facility, that is $50 per day, maximum of 2 days per calendar year per covered person.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] And then
[AGENT][NEUTRAL] So this is just for accident and sickness, which
[AGENT][NEUTRAL] I mean urgent care, I would assume they'd be sick.
[AGENT][NEUTRAL] Um,
[AGENT][NEUTRAL] It looks like per the policy, primary care and urgent care are not covered, and this is a guarantee of payment. This is not a guarantee payment, it's just a verification of coverage.
[AGENT][NEUTRAL] Yeah, so it looks like the urgent care facility is just $50 per day.
[CUSTOMER][NEUTRAL] OK, thank you. um, may I ask you, do they have a network with their plan?
[AGENT][NEUTRAL] OK, just a moment. Let me see.
[AGENT][NEGATIVE] So, no.
[AGENT][NEGATIVE] No network with their plan.
[CUSTOMER][NEUTRAL] OK, thank you and may I have the claims address and payer ID please?
[AGENT][POSITIVE] Yes, of course.
[AGENT][NEUTRAL] So the claim address is PO Box.
[AGENT][NEUTRAL] 248 9.
[AGENT][NEUTRAL] 50
[AGENT][NEUTRAL] [PII].
[AGENT][NEUTRAL] [PII].
[AGENT][NEUTRAL] 73124
[AGENT][NEUTRAL] And the payer ID is 60801.
[CUSTOMER][NEUTRAL] OK, and that was PO Box 248,950, is that correct?
[AGENT][NEUTRAL] Yes, ma'am. Mhm
[CUSTOMER][NEUTRAL] OK, and then one more question please, could I have the group number?
[AGENT][NEUTRAL] Yes.
[AGENT][NEUTRAL] The group number is 70075.
[CUSTOMER][NEUTRAL] Thank you. And just your name and a call reference number, please.
[AGENT][NEUTRAL] Yes, my name is [PII]
[AGENT][NEUTRAL] And that's also a part of the reference number, so it would be my first name, last initial [PII], and then today's date.
[CUSTOMER][POSITIVE] OK, thank you so much for your help. I appreciate it.
[AGENT][POSITIVE] You're welcome, of course. Is there anything else I can help you with today?
[CUSTOMER][POSITIVE] No, ma'am, that was it. I hope you have a great weekend.
[AGENT][POSITIVE] OK. Thank you. You too. Thanks for calling APL.
[CUSTOMER][POSITIVE] Thank you. Bye-bye.
[AGENT][NEUTRAL] OK, bye.