AccountId: 011433970860
ContactId: c3da31e6-2678-4ea7-8bef-607cd5a6d4ab
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 321850 ms
Total Talk Time (AGENT): 123062 ms
Total Talk Time (CUSTOMER): 149575 ms
Interruptions: 1
Overall Sentiment: AGENT=2.2, CUSTOMER=0.4
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/04/02/c3da31e6-2678-4ea7-8bef-607cd5a6d4ab_20250402T17:12_UTC.wav
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[AGENT][POSITIVE] Good morning. Thank you for calling APL. My name is [PII]. How may I help you?
[CUSTOMER][NEUTRAL] Hello, [PII]. This is [PII] from Urology Specialist Group to check benefits.
[AGENT][POSITIVE] It would be my pleasure to assist you. Do you mind spelling your name for documentation?
[CUSTOMER][NEUTRAL] Uh yes, [PII]. Last name initial is [PII].
[AGENT][POSITIVE] Thank you, [PII].
[AGENT][POSITIVE] Thank you. That is a beautiful name, [PII]. What is a good callback number, please?
[CUSTOMER][NEUTRAL] Yes.
[CUSTOMER][NEUTRAL] [PII]
[AGENT][NEUTRAL] Thank you. And the policy number for the patient, please?
[CUSTOMER][NEUTRAL] Uh, yes, one moment.
[CUSTOMER][NEUTRAL] It's 02216343.
[AGENT][NEUTRAL] 63
[CUSTOMER][NEUTRAL] M for Mike, L Lima 70 sorry, it's
[AGENT][POSITIVE] Thank you. And that's fine. I apologize. 6343?
[CUSTOMER][NEUTRAL] M as in Mike, L Lima 7.
[AGENT][NEUTRAL] Thank you. And the patient's name and date of birth?
[CUSTOMER][NEUTRAL] As [PII] and [PII].
[AGENT][POSITIVE] All right, thank you.
[AGENT][NEUTRAL] I have Mr. [PII]'s policy pulled up. Are you needing eligibility or claim status?
[CUSTOMER][NEUTRAL] Uh, both.
[AGENT][NEUTRAL] OK, so the policy number that you gave me is an old policy that's no longer active as of [PII]. He does have active coverage under another policy number.
[CUSTOMER][NEUTRAL] Please.
[CUSTOMER][NEUTRAL] Oh
[CUSTOMER][NEUTRAL] With
[CUSTOMER][NEUTRAL] OK. Allow me one moment and let me hide this policy and then we can access the another one.
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] America.
[CUSTOMER][NEUTRAL] 46
[CUSTOMER][POSITIVE] OK, I'm ready for the other.
[AGENT][NEUTRAL] As of
[CUSTOMER][NEUTRAL] Member ID for the new.
[AGENT][NEUTRAL] OK. As of [PII], we's active policy number is 025.
[AGENT][NEUTRAL] 03163
[CUSTOMER][NEUTRAL] And any letters or just the numbers?
[AGENT][NEUTRAL] Just the numbers, the letters are not required.
[CUSTOMER][NEUTRAL] OK, it's 0 for confirm. 02503163. Am I correct?
[AGENT][NEUTRAL] Mhm.
[AGENT][POSITIVE] That is, that is correct.
[CUSTOMER][NEUTRAL] OK, and do you have the effective date of, of this policy, the new policy?
[AGENT][NEUTRAL] It's 71-2024.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][POSITIVE] Excellent, thank you so much.
[AGENT][POSITIVE] My pleasure. Anything else I can help you with today?
[CUSTOMER][NEUTRAL] Yes, one moment, I'm not turn.
[CUSTOMER][NEUTRAL] And for the outpatient diagnosis services for this member are covered to which the amount.
[AGENT][NEUTRAL] For outpatient, he has coverage up to
[AGENT][NEUTRAL] $1500. Now that is a verification of coverage and not a guarantee of payment.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK. And any accumulation of this year?
[AGENT][NEGATIVE] As of right now, he has not used any of that benefit.
[CUSTOMER][NEUTRAL] Or this month?
[CUSTOMER][NEUTRAL] OK, and this policy cover our copays, car insurance, deductible?
[AGENT][NEUTRAL] It
[CUSTOMER][NEUTRAL] An office basic?
[AGENT][NEUTRAL] For office visit, the visit is not covered.
[AGENT][NEUTRAL] But procedures or treatments in office can be considered for benefits.
[CUSTOMER][NEUTRAL] OK, right.
[CUSTOMER][NEUTRAL] OK, let me know if I have the correct information. So the new member ID, um, give me one moment.
[CUSTOMER][NEUTRAL] The new member ID that is 0250.
[CUSTOMER][NEUTRAL] 3163 effective date of [PII]. No termination date. Um, the outpatient diagnosis services are covered up to $1500 and at this time, Serraed. And they cover the copays. OK, it's, and the office visits are not covered.
[AGENT][NEUTRAL] Mhm.
[AGENT][NEUTRAL] Mhm.
[AGENT][POSITIVE] That is correct.
[AGENT][NEUTRAL] Correct, and those benefits given over the phone is a verification of coverage on the policy, not a guarantee of payment.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK, excellent, [PII]. Do you have a reference number?
[AGENT][POSITIVE] The reference number is my name and today's date, and I spell my name [PII], it was a pleasure to assist you with those benefits. Anything else I can help you with today?
[CUSTOMER][POSITIVE] Justice. Thank you so much, [PII]. Have a wonderful day. Bye bye.
[AGENT][POSITIVE] Hope you have a wonderful day as well and thank you for calling APL. Bye-bye.
[CUSTOMER][NEUTRAL] Bye-bye.