AccountId: 011433970860
ContactId: bd2e5100-97b5-4bdb-92fa-91f4dce8bff0
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 284679 ms
Total Talk Time (AGENT): 100928 ms
Total Talk Time (CUSTOMER): 119230 ms
Interruptions: 0
Overall Sentiment: AGENT=1.5, CUSTOMER=0.3
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/04/04/bd2e5100-97b5-4bdb-92fa-91f4dce8bff0_20250404T14:55_UTC.wav
--------------------------------------------
[AGENT][POSITIVE] Thanks for calling APL. This is [PII]. How may I assist you?
[CUSTOMER][NEUTRAL] Hi, good morning. um, I'm calling to check benefits, uh, and eligibility for one of our, uh, patients.
[AGENT][POSITIVE] Sure, I can assist you with that. Can I have your name and a callback number?
[CUSTOMER][NEUTRAL] I'm sorry?
[AGENT][NEUTRAL] Can I have your name and a callback number?
[CUSTOMER][NEUTRAL] Sure, it's [PII], callback number [PII].
[AGENT][NEUTRAL] Thank you and what is the policy number of the member that you're calling to verify benefits for today, Luy?
[CUSTOMER][NEUTRAL] It is 02554589, M as in Mary, L as in love, 8.
[AGENT][NEUTRAL] Can you verify the patient's name and date of birth?
[CUSTOMER][NEUTRAL] Absolutely. Uh, date of birth is [PII] and the last name is [PII]
[CUSTOMER][NEUTRAL] [PII]
[CUSTOMER][NEUTRAL] And the first name is [PII]
[CUSTOMER][NEUTRAL] I'm sorry, I didn't catch your name.
[AGENT][NEUTRAL] My name is [PII].
[AGENT][NEUTRAL] [PII].
[CUSTOMER][NEUTRAL] Can you spell that for me?
[AGENT][NEUTRAL] You're calling to verify benefits and eligibility for what place of service?
[CUSTOMER][NEUTRAL] Uh, hospital, um, outpatient office visit. It's a doctor that's, uh, part of a hospital.
[AGENT][NEUTRAL] So this member's policy does not have office visits covered under the policy. However, the treatment received in the office is covered, which falls under her outpatient benefits.
[AGENT][NEUTRAL] And her outpatient benefits are?
[CUSTOMER][NEUTRAL] So treatment
[AGENT][NEUTRAL] $1500 per calendar year and this is not a guaranteed benefits just a disclaimer of the policy's coverage so the visit itself.
[CUSTOMER][NEUTRAL] How much is that? I'm sorry, I didn't, I didn't hear you.
[AGENT][NEUTRAL] $1500 per calendar year.
[CUSTOMER][NEUTRAL] How much is the outpatient?
[CUSTOMER][NEUTRAL] 200
[AGENT][NEUTRAL] 1500, 1500. Are, are you not able to hear me?
[CUSTOMER][NEUTRAL] Oh
[CUSTOMER][NEUTRAL] Oh, I'm sorry, I can't hear you.
[CUSTOMER][NEUTRAL] Calendar year.
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] And how much has she got used?
[AGENT][NEUTRAL] $930.
[CUSTOMER][NEUTRAL] $130. OK, uh, question. So she cannot see the doctor as, um, for an office visit, even if it's hospital 7.
[AGENT][NEUTRAL] No, no, I didn't say she could not see him. I'm saying that we won't cover the office visit, but we will cover the treatment received in the office.
[CUSTOMER][NEUTRAL] Right, so
[CUSTOMER][NEUTRAL] OK, so office visit not covered, but treatment will.
[AGENT][POSITIVE] Right, that's correct. Yes, that's correct.
[CUSTOMER][NEUTRAL] OK, perfect. Um, OK. Are any labs, that's considered labs and everything, anything outpatient, right?
[AGENT][NEUTRAL] You see, so, um, if it's place the service 11, it won't be considered as outpatient. It'll be considered as an office visit, but the treatment received in the office would fall under her outpatient benefits.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Um, and what is your, is there a reference number to this call?
[AGENT][NEUTRAL] We don't provide those, however, you can use my name in today's date as a reference, and she does have lab services if it's actually a a lab facility, it falls under her lab benefits which falls under her outpatient benefits.
[CUSTOMER][NEUTRAL] OK, so labs or anything done outpatient treatments is 1500 and she's accumulated 930.
[CUSTOMER][NEGATIVE] So far.
[AGENT][POSITIVE] Yes, that is correct, loopy.
[CUSTOMER][NEUTRAL] And office visit not covered.
[AGENT][POSITIVE] Correct.
[CUSTOMER][NEUTRAL] All right. And you told me that your name is [PII]?
[AGENT][NEUTRAL] LA
[CUSTOMER][POSITIVE] LA, OK, perfect. Thank you so much. You have a great day, OK?
[AGENT][POSITIVE] Thanks for calling APO you have a great one as well. Thank you.
[CUSTOMER][POSITIVE] Thank you bye bye.
[AGENT][NEUTRAL] Bye.