AccountId: 011433970860
ContactId: c74691e5-e27c-40b4-94e0-963e08a8c6d6
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 218699 ms
Total Talk Time (AGENT): 98244 ms
Total Talk Time (CUSTOMER): 120990 ms
Interruptions: 6
Overall Sentiment: AGENT=1.1, CUSTOMER=0.6
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/05/19/c74691e5-e27c-40b4-94e0-963e08a8c6d6_20250519T15:03_UTC.wav
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[AGENT][POSITIVE] Thanks for calling APL. This is [PII]. How may I assist you?
[AGENT][NEUTRAL] Hello, thanks for calling APL. This is [PII]. How may I assist you?
[CUSTOMER][NEUTRAL] Hi [PII], how are you? Sorry, you're on mute. Um, I have a mutual patient. I need to know what her gap insurance covers.
[AGENT][POSITIVE] Sure, I can assist you with that. Can I have your name and a callback number?
[CUSTOMER][NEUTRAL] My name is [PII]. Callback number is [PII].
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] So, could you provide me with the spelling of your name?
[CUSTOMER][NEUTRAL] [PII]
[AGENT][NEUTRAL] You said [PII]?
[CUSTOMER][POSITIVE] OK perfect I'm gonna call you.
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] Thank you, [PII]. Can I have that policy number of the member that you're calling to verify benefits for today?
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] Yes ma'am, 01791409.
[AGENT][NEUTRAL] [PII], could you verify the patient's name and date of birth, and I'll be able to assist you.
[CUSTOMER][NEUTRAL] So the doctor recommended
[CUSTOMER][POSITIVE] Yes, [PII] you're very welcome have a great day.
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] And date of birth is [PII].
[AGENT][NEUTRAL] Thank you, [PII]. You're calling to verify benefits and eligibility. This member's policy has been active since [PII] and is currently active, and you're calling to verify outpatient benefits.
[CUSTOMER][NEUTRAL] And.
[CUSTOMER][NEUTRAL] O.
[CUSTOMER][NEUTRAL] one.
[CUSTOMER][NEUTRAL] Yeah, one second, [PII] of what year?
[CUSTOMER][NEUTRAL] You said [PII]?
[AGENT][NEUTRAL] [PII].
[CUSTOMER][NEUTRAL] [PII]. OK, so our office visits covered with this policy?
[AGENT][NEUTRAL] Yeah, the member has a physician rider which covers her office visits up to $25 per visit and this is not a guarantee of benefits, just a disclaimer of the policy's coverage.
[AGENT][NEUTRAL] With 4 visits per calendar year.
[CUSTOMER][NEUTRAL] I covered up.
[CUSTOMER][NEUTRAL] It covers up to $25 per visit for visits per calendar, sorry, I just read everything calendar and she's used 2 you said?
[AGENT][NEUTRAL] Mhm. Per visit with 4 visits per calendar year and she has utilized 2 of those visits.
[AGENT][POSITIVE] Mhm, that's correct.
[CUSTOMER][NEUTRAL] OK, to use and for any office procedure is anything covered?
[AGENT][NEUTRAL] Falls under her physician rider.
[CUSTOMER][NEUTRAL] Um, I
[CUSTOMER][NEUTRAL] I'm sorry?
[AGENT][NEUTRAL] It falls under the same benefit that I just provided you with the physician rider of the $25 per visit with 4 visits per calendar year.
[CUSTOMER][NEUTRAL] Mm.
[CUSTOMER][NEUTRAL] OK, alright, so co-pays are not covered.
[AGENT][NEUTRAL] Is there anything else that I can assist you with?
[AGENT][NEUTRAL] No, what I'm saying is, no, so what I'm saying is the benefits that I just expressed to you, the, the visit and the treatment received in the office is all combined in that $25.
[CUSTOMER][NEUTRAL] Yeah, co-pays are not covered, right?
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Mhm
[AGENT][POSITIVE] Benefit amount.
[CUSTOMER][POSITIVE] Oh wow, so that's pretty much nothing. OK, alright, my love, perfect, we're all set then.
[AGENT][NEUTRAL] Mhm.
[AGENT][NEUTRAL] Is there anything else that I can assist you with today?
[CUSTOMER][NEUTRAL] Yes, uh, can I get a reference, uh, number or your name?
[AGENT][NEUTRAL] We don't provide those, but you can use my name and today's date as a reference is [PII], and today's date.
[CUSTOMER][POSITIVE] All right, sounds good thank you so much.
[AGENT][POSITIVE] Thanks for calling APL. Have a great day. Goodbye.
[CUSTOMER][NEUTRAL] [PII].
[CUSTOMER][NEUTRAL] You too bye.