AccountId: 011433970860
ContactId: c1214070-e604-46ab-992e-c026230eb064
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 236570 ms
Total Talk Time (AGENT): 137311 ms
Total Talk Time (CUSTOMER): 78312 ms
Interruptions: 3
Overall Sentiment: AGENT=1.2, CUSTOMER=0.6
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/04/11/c1214070-e604-46ab-992e-c026230eb064_20250411T13:46_UTC.wav
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[AGENT][POSITIVE] Good morning. Thank you for calling APL. This is [PII]. How can I help you?
[CUSTOMER][NEUTRAL] Hi, [PII], uh, this is [PII] with Pinnacle Family Healthcare, and I, I'm needing to see what the benefits are for this patient, please.
[AGENT][NEUTRAL] Yes, ma'am.
[AGENT][NEUTRAL] OK, [PII], so do you also need eligibility or only benefit information?
[CUSTOMER][NEUTRAL] uh, I'll take eligibility and benefits, mhm.
[AGENT][NEUTRAL] OK, so yes ma'am, I can help you with both and what is your callback number please, [PII]?
[CUSTOMER][NEUTRAL] [PII]
[AGENT][POSITIVE] Thank you and the member's policy number please.
[CUSTOMER][NEUTRAL] It is 1462947.
[AGENT][NEUTRAL] OK, thank you one moment while I get the member's information pulled up please.
[CUSTOMER][NEUTRAL] OK.
[AGENT][POSITIVE] Thank you.
[AGENT][NEUTRAL] And any information, [PII], that I do provide for you today would be a verification of benefits and not a guarantee of payment. What is your patient's name and their date of birth?
[CUSTOMER][NEUTRAL] [PII] and the date of birth is [PII].
[AGENT][POSITIVE] OK, thank you.
[AGENT][NEUTRAL] OK, so she is the subscriber on the supplemental policy, and this supplemental policy is active, [PII], with an effective date of [PII]. And what type of benefit information do you need for her inpatient, outpatient or office?
[CUSTOMER][NEUTRAL] Office visit.
[AGENT][NEUTRAL] One moment.
[AGENT][NEUTRAL] OK, so on this supplemental policy, Jackie, office visits are not covered.
[CUSTOMER][NEUTRAL] Not covered, OK.
[AGENT][NEUTRAL] Correct. If she were to receive some form of treatment in the office, that could be reviewed under her outpatient benefit maximum. However, office visits are not covered.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] I got you so it helped with lab work and anything like that, but just not office visit?
[AGENT][NEUTRAL] For now, the lab writer that she has would be for lab work done outside.
[AGENT][NEUTRAL] Like sent to an independent lab.
[CUSTOMER][NEUTRAL] OK, outside of the business.
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] OK, alrighty, got you. OK, uh, that we do send it outside anyway, so that, that'd be good, uh, OK, uh, that.
[AGENT][NEUTRAL] OK, so her, do you need her outpatient benefits then or her maximum benefit? OK. Right.
[CUSTOMER][NEUTRAL] No, uh uh.
[CUSTOMER][NEUTRAL] What's the maxim well, no, because it's not covered nothing's covered here, so that answers my question.
[AGENT][NEUTRAL] OK, well, is yes ma'am, and just one additional thing I'm gonna go ahead and give you our portal website, Jackie because for future reference if you all were to file a claim with us once it's been processed, we have a portal that you should be able to check claim status in and our website for the portal is located at [PII].
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] [PII] what?
[AGENT][NEUTRAL] [PII].
[CUSTOMER][NEUTRAL] [PII], OK.
[AGENT][NEUTRAL] This plan.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] All right. And is there anything else? OK. Well, is there anything else?
[CUSTOMER][NEUTRAL] Alrighty, I will put that in my notes.
[CUSTOMER][POSITIVE] No, that's what that's all I needed.
[AGENT][POSITIVE] OK. Well, thank you again.
[CUSTOMER][NEUTRAL] And what was your name again?
[AGENT][NEUTRAL] [PII], and my name and today's date will be your call reference number?
[CUSTOMER][POSITIVE] Alrighty, uh, thank you, [PII]. Good day.
[AGENT][POSITIVE] All right. Well, you're welcome and thank you for calling APL. I hope you have a nice day as well.
[CUSTOMER][NEUTRAL] Mhm
[CUSTOMER][POSITIVE] OK thanks bye bye.
[AGENT][NEUTRAL] Mhm, bye-bye.