AccountId: 011433970860
ContactId: c6a97afb-78ea-47f1-a515-4354fa648678
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 229520 ms
Total Talk Time (AGENT): 118461 ms
Total Talk Time (CUSTOMER): 69135 ms
Interruptions: 1
Overall Sentiment: AGENT=1.2, CUSTOMER=1.2
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/04/02/c6a97afb-78ea-47f1-a515-4354fa648678_20250402T17:41_UTC.wav
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[AGENT][NEUTRAL] Good afternoon. Thank you for calling APL. This is [PII]. How can I help you?
[CUSTOMER][NEUTRAL] Uh, uh, this is [PII] calling from the Decatur lines, and how are you doing today?
[AGENT][POSITIVE] I'm good, [PII]. How are you doing today?
[CUSTOMER][POSITIVE] Doing great thanks for asking. Actually I have a patient.
[AGENT][POSITIVE] Good. Well, how can I help you?
[CUSTOMER][NEUTRAL] Yeah, I'm a patient and I already taken the benefits and the fax back. Uh, I just couldn't find the used amounts in the fax pack, so I just called you.
[AGENT][NEUTRAL] Uh
[AGENT][NEUTRAL] OK, so you're needing to get what has been used so far for the member, is that correct?
[CUSTOMER][NEUTRAL] Yeah
[CUSTOMER][POSITIVE] Yeah, that's correct.
[AGENT][NEUTRAL] Yes, I can help you with that, [PII]. And what is your callback number, please?
[CUSTOMER][NEUTRAL] It's [PII].
[CUSTOMER][NEUTRAL] [PII]
[CUSTOMER][NEUTRAL] [PII] and it's a direct line.
[AGENT][POSITIVE] OK, thank you.
[AGENT][NEUTRAL] OK, perfect. Thank you. And what is the member's policy number?
[CUSTOMER][NEUTRAL] 022 04158.
[AGENT][POSITIVE] OK, thank you, [PII]. Give me just a couple of moments, please, to get the member's information pulled up. Thank you.
[CUSTOMER][NEUTRAL] Sure.
[AGENT][NEUTRAL] And [PII], any information that I do provide for you will be a verification of benefits and not a guarantee of payment. What is your patient's name and date of birth?
[CUSTOMER][NEUTRAL] Uh, patient is [PII] and the date of birth is [PII].
[AGENT][NEUTRAL] OK, thank you very much. So I can, and you are needing to know what the accumulation and what has been used for this calendar year, is that correct?
[CUSTOMER][POSITIVE] Yeah, that's correct.
[AGENT][NEUTRAL] OK. So as of now, she has met her calendar year deductible.
[AGENT][NEUTRAL] And she has used $121.80 of the calendar year maximum benefit.
[CUSTOMER][NEUTRAL] Sure.
[CUSTOMER][NEUTRAL] Uh, thank you. And what is, uh, major coverage percentage?
[AGENT][POSITIVE] You're welcome.
[AGENT][NEUTRAL] As you can see on that fax back, there is major services are not covered.
[CUSTOMER][NEUTRAL] The plan
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEGATIVE] If it's not on the facts that day, that means it's not covered under this plan.
[CUSTOMER][NEUTRAL] Yeah, uh,
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] And yep, that's all the information I wanted today and before that, is there a network participation for the provider?
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] I'm sorry, say that, ask that question again.
[CUSTOMER][NEUTRAL] Uh,
[CUSTOMER][NEUTRAL] Like, is there a network participation for like for the provider in network or out of network?
[AGENT][NEUTRAL] OK, as you can also see on the
[AGENT][NEUTRAL] OK, so as you can see on the fax back this plan participates with the Carrington PPO network. however, they are not required to use a network provider.
[CUSTOMER][POSITIVE] Uh, thank you so much for the information and have a great day bye for now.
[AGENT][NEUTRAL] Absolutely. You take [PII], if that's all then that I can help you with. Thank you again for calling APL. And one last thing, [PII], when you called a while ago, um, to get your facts back, did they give you our portal website so that if you all do file a claim.
[CUSTOMER][POSITIVE] Take care.
[AGENT][NEUTRAL] Um, that can be, you can check claim status [PII].
[CUSTOMER][NEUTRAL] Yeah
[CUSTOMER][NEUTRAL] Yeah, uh
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] Yeah, and they have given the what that.
[AGENT][POSITIVE] OK, good. All right then. Well, again, thank you for calling APL if that's all I can help with, and I hope you have a wonderful rest of your day.
[CUSTOMER][POSITIVE] Same to you bye bye thank you.
[AGENT][NEUTRAL] No, thank you. Bye bye.