AccountId: 011433970860
ContactId: bad58ccf-0977-4fe7-9945-656656fbb82c
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 220169 ms
Total Talk Time (AGENT): 78049 ms
Total Talk Time (CUSTOMER): 73612 ms
Interruptions: 0
Overall Sentiment: AGENT=0.6, CUSTOMER=0.6
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/02/04/bad58ccf-0977-4fe7-9945-656656fbb82c_20250204T14:24_UTC.wav
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[AGENT][POSITIVE] And thank you for calling APR. This is [PII]. How can I help you?
[CUSTOMER][NEUTRAL] Uh, hi, my name is [PII] from provider's office checking on members' eligibility and benefits for the medical.
[AGENT][NEUTRAL] I'm sure, [PII], I can assist you with benefits. Um, first, I'll need a good callback number just in case we're disconnected.
[CUSTOMER][NEUTRAL] [PII] direct line. And could you also please spell me your name?
[AGENT][NEUTRAL] My name is [PII], um, it's spelled [PII] and my last initial is [PII].
[AGENT][POSITIVE] And thank you, [PII]. Could I get a good callback number just in case we're disconnected?
[CUSTOMER][NEUTRAL] [PII]
[CUSTOMER][NEUTRAL] [PII] direct line, no extension.
[AGENT][NEUTRAL] Thank you. Now, I need the policy number, please.
[CUSTOMER][NEUTRAL] Uh, the policy number would be 02287616.
[AGENT][NEUTRAL] Please verify the patient's name and date of birth.
[CUSTOMER][NEUTRAL] It's [PII]. [PII].
[AGENT][NEUTRAL] Thank you. Now, I need the date of service and bill charges on the claim.
[CUSTOMER][NEUTRAL] No, actually members eligibility and benefits.
[AGENT][NEUTRAL] OK, just let me advise you the verification of coverage does not guarantee payment of claims. The effective date on this policy was [PII] and the policy is still active.
[AGENT][NEUTRAL] OK. And is this for anti
[CUSTOMER][NEUTRAL] And I
[AGENT][NEUTRAL] Go ahead.
[CUSTOMER][NEUTRAL] Yeah. Uh, this is for the outpatient, uh, colonoscopy diagnostic done in office setting.
[AGENT][NEUTRAL] OK. Actually, under this policy for services provided in office, there's no coverage.
[CUSTOMER][NEUTRAL] OK, so the services which are covered in, uh, I mean rendering in the office, there is no coverage, you mean?
[AGENT][NEUTRAL] Yes, sir.
[CUSTOMER][NEUTRAL] What about when it done in an outpatient hospital?
[AGENT][NEUTRAL] Right, if it's done in an outpatient hospital or outpatient facility, we cover up to 1500 per calendar year.
[CUSTOMER][NEUTRAL] OK, thanks for that information. So when the services, when any services remain in office setting, there is no coverage for this number, right?
[AGENT][NEUTRAL] That's correct. Um, unless it's for cancer treatment.
[AGENT][NEUTRAL] If the member has cancer and is, yeah, right.
[CUSTOMER][NEUTRAL] OK. Only the
[CUSTOMER][POSITIVE] Thank you, ma'am, and just a moment please.
[AGENT][NEUTRAL] Sure.
[CUSTOMER][NEUTRAL] Thanks for that information. Can I get the reference number?
[AGENT][NEUTRAL] Yes, so the reference number, you can use my name and today's date. Is there anything else that I can assist you with?
[CUSTOMER][POSITIVE] Thank you. That's it for the day, [PII]. You have a great day.
[AGENT][NEUTRAL] You do the same, [PII]. Thank you for calling APL. Mm bye.