AccountId: 011433970860
ContactId: babea4e8-58fa-4b27-ac32-29381784c6da
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 187979 ms
Total Talk Time (AGENT): 94736 ms
Total Talk Time (CUSTOMER): 72382 ms
Interruptions: 0
Overall Sentiment: AGENT=0.8, CUSTOMER=0.4
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/02/26/babea4e8-58fa-4b27-ac32-29381784c6da_20250226T16:02_UTC.wav
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[AGENT][POSITIVE] Good morning. Thank you for calling. This is [PII]. May I help you?
[CUSTOMER][NEUTRAL] Oh.
[CUSTOMER][NEUTRAL] Hi, yes, I'm calling for benefits and eligibility please for one of our patients.
[AGENT][NEUTRAL] OK, I can verify benefits and eligibility for you. And your name is?
[CUSTOMER][NEUTRAL] [PII] spelled [PII] I'm sorry, your name is?
[AGENT][NEUTRAL] Uh it's [PII] last initial [PII] and Ms. [PII], what's that policy number, please?
[CUSTOMER][NEUTRAL] It's gonna be, of course, 02064065.
[AGENT][NEUTRAL] OK, thank you. One moment. And do you have a callback number in case the call drops?
[CUSTOMER][NEUTRAL] Yes, [PII].
[AGENT][NEUTRAL] OK. And the patient's name, date of birth?
[CUSTOMER][NEUTRAL] Um, it's gonna be [PII] [PII].
[AGENT][NEUTRAL] OK, I'm showing his effective date is [PII]. He is active under the policy and what benefits are you needing for this patient?
[CUSTOMER][NEUTRAL] I
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] An office visit and outpatient surgery done in the specialist office setting.
[AGENT][NEUTRAL] OK, uh, not a guarantee of payment, just a verification of coverage. For office visits, the max payable is up to $25 per visit. It has a total of 4 visits per year. And you said the procedure is going to be an outpatient facility?
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] It's gonna be an outpatient surgery, so the plan pays up to $25 per visit.
[AGENT][NEUTRAL] For, for the visit, yes, ma'am. So the procedure is
[CUSTOMER][NEUTRAL] And it's 4 visits?
[AGENT][NEUTRAL] 4 visits per year.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] And the procedure is going to be done in the doctor's office as well, or is it an outpatient facility?
[CUSTOMER][NEUTRAL] In the doctor's office as well.
[AGENT][NEUTRAL] Oh, well, there's not a separate benefit as far as procedures in office, so it would just go towards that $25 for the physician. Yes, ma'am.
[CUSTOMER][NEUTRAL] I'll pay.
[CUSTOMER][NEUTRAL] OK, yes, but the, the outpatient, I know they, I called last month and they said that it, the plan pays up to $500 per diagnosis. Is that still the
[AGENT][NEUTRAL] Well,
[AGENT][NEUTRAL] That's for outpatient, yes, ma'am, but outpatient is considered ER, urgent care, ambulatory surgery center, MRI or imaging center, not a physician's office.
[CUSTOMER][POSITIVE] OK, perfect.
[CUSTOMER][NEUTRAL] So the plan pays up to 25.
[CUSTOMER][NEUTRAL] Before visit and
[CUSTOMER][NEUTRAL] Mm. And how much of the visits have been used?
[AGENT][NEUTRAL] Uh, give me a moment.
[AGENT][NEUTRAL] Uh, don't show any benefits have been used for this year, so it is available.
[CUSTOMER][NEUTRAL] OK, so 0 visits has been used for the office visit.
[AGENT][POSITIVE] Correct.
[CUSTOMER][NEUTRAL] OK perfect and a reference number?
[AGENT][NEUTRAL] Uh, we don't give reference numbers, but you may use my name in today's date.
[CUSTOMER][POSITIVE] Thank you so much you have a great rest of your day.
[AGENT][POSITIVE] Oh, you too, and thanks for calling APL.
[CUSTOMER][NEUTRAL] Right
[CUSTOMER][NEUTRAL] Right