AccountId: 011433970860
ContactId: bd9639d9-0356-4ce3-95e3-798ca2fc1858
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 198520 ms
Total Talk Time (AGENT): 90844 ms
Total Talk Time (CUSTOMER): 48790 ms
Interruptions: 0
Overall Sentiment: AGENT=1.7, CUSTOMER=0.3
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/04/14/bd9639d9-0356-4ce3-95e3-798ca2fc1858_20250414T16:02_UTC.wav
--------------------------------------------
[AGENT][POSITIVE] Thanks for calling APL. This is [PII]. How may I assist you?
[CUSTOMER][NEUTRAL] Hi, I'm calling to uh verify benefits and eligibility.
[AGENT][POSITIVE] Sure, I can assist you with that. Can I have your name and a callback number?
[CUSTOMER][NEUTRAL] Yeah, it's gonna be [PII]. Callback number is gonna be [PII].
[AGENT][NEUTRAL] And could you provide me with the spelling of your name?
[CUSTOMER][NEUTRAL] [PII]
[CUSTOMER][NEUTRAL] [PII]
[AGENT][NEUTRAL] So I'm not sure if you said [PII].
[CUSTOMER][NEUTRAL] No, she
[AGENT][NEUTRAL] So, could you provide me with the spelling again? Uh-huh.
[CUSTOMER][NEUTRAL] [PII]
[CUSTOMER][NEUTRAL] [PII]
[AGENT][NEUTRAL] So, [PII].
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] Thank you. Can I have the policy number of the member that you're calling to verify benefits and eligibility for?
[CUSTOMER][NEUTRAL] Yes, it's gonna be 0257.
[CUSTOMER][NEUTRAL] 9505.
[AGENT][POSITIVE] Thank you. Could you verify the patient's name and date of birth and I'll be able to assist you.
[CUSTOMER][NEUTRAL] It's gonna be [PII].
[CUSTOMER][NEUTRAL] And [PII] is the date of birth.
[AGENT][NEUTRAL] And you're calling to verify benefits eligibility for what place of service?
[CUSTOMER][NEUTRAL] Yes.
[CUSTOMER][NEUTRAL] For a gastro specialist.
[AGENT][NEUTRAL] So this policy does not cover the office visit itself, however, it does cover the treatment received in the office, which falls under her outpatient benefits of $3150 per calendar year. And this is not a guaranteed benefits, just a disclaimer of the policy's coverage. It does not cover the office visit, but the treatment received in the office is covered.
[CUSTOMER][NEUTRAL] So it doesn't cover the whole?
[CUSTOMER][NEUTRAL] OK. Can I get um the effective date?
[AGENT][NEUTRAL] If that makes sense.
[AGENT][NEUTRAL] Sure, give me one moment.
[AGENT][POSITIVE] This policy became effective.
[AGENT][NEUTRAL] [PII] and is currently active and the member has not utilized any of their benefits for [PII].
[CUSTOMER][NEUTRAL] OK, um, do they need a referral or authorization?
[AGENT][NEUTRAL] No, this is a gap insurance. They don't need a pre-authorization.
[CUSTOMER][NEUTRAL] OK, can I get um the reference number?
[AGENT][NEUTRAL] We don't provide those. However, you can use my name in today's today's date as a reference. My name is [PII] and today's date as a reference. Is there anything else that I can assist you with today?
[CUSTOMER][POSITIVE] That'll be all. Thank you.
[AGENT][POSITIVE] You're welcome