AccountId: 011433970860
ContactId: c90b69a7-223f-4419-b7d7-4369086d15bd
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 174750 ms
Total Talk Time (AGENT): 64689 ms
Total Talk Time (CUSTOMER): 62231 ms
Interruptions: 0
Overall Sentiment: AGENT=1.1, CUSTOMER=0.6
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/06/09/c90b69a7-223f-4419-b7d7-4369086d15bd_20250609T17:18_UTC.wav
--------------------------------------------
[AGENT][NEUTRAL] For calling APL, my name is [PII]. How can I assist you today?
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Uh, yes, uh, hi, sir. My name is [PII] calling from the provider's office.
[AGENT][POSITIVE] I'd be happy to assist. Um, how can I help you today, [PII]?
[CUSTOMER][NEUTRAL] Uh, yes, uh, I just need to help with the members, uh, eligibility and benefits information please.
[AGENT][POSITIVE] I'll be happy to assist with eligibility and benefits if I can get a good callback number for you.
[CUSTOMER][NEUTRAL] Sure, it's uh [PII].
[CUSTOMER][NEUTRAL] [PII]
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] And what is the policy number?
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Policy number is 023.
[CUSTOMER][NEUTRAL] 696
[CUSTOMER][NEUTRAL] 96
[CUSTOMER][NEUTRAL] ML 8.
[AGENT][NEUTRAL] Patient's name and date of birth.
[CUSTOMER][NEUTRAL] Patient's name is [PII].
[CUSTOMER][NEUTRAL] Date of birth would be [PII].
[AGENT][NEUTRAL] Thank you for that information. Please be advised the verification of coverage is not a guarantee of payment. I do show the policy is currently active. Effective date is excuse me, [PII]. And are you calling for inpatient or outpatient benefits?
[CUSTOMER][NEUTRAL] Uh, inpatient, please.
[AGENT][NEUTRAL] I do show the inpatient calendar year maximum is 4, excuse me, $4050.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] 15
[CUSTOMER][NEUTRAL] Alright, and, uh, uh, does the member have uh any office visits like copay and go to?
[AGENT][NEUTRAL] So that would be considered outpatient. The outpatient calendar year maximum is $2,025 and patient has benefits for treatment and procedures at the visit, um, but no benefits for the physician's charges associated with the co-pay.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] No.
[CUSTOMER][NEUTRAL] And there's no out of pocket benefits as well, right?
[AGENT][NEGATIVE] I don't understand the question.
[CUSTOMER][NEUTRAL] No, it does the member have any out of pocket expense.
[AGENT][NEUTRAL] That will be a question for their major medical, with their gap insurance.
[CUSTOMER][NEUTRAL] Oh, OK, OK, I understand that. OK.
[CUSTOMER][NEUTRAL] Uh, yeah, I think, uh, that's all I have for now. Uh, thank you so much, sir. Do you have a reference number for me?
[AGENT][NEUTRAL] Thank you for calling. Reference is just my name [PII] last initial [PII], and the date and time of the call.
[CUSTOMER][POSITIVE] Alright, OK, thank you so much, yeah.
[AGENT][POSITIVE] Thank you for calling APL. Have a good day.
[CUSTOMER][POSITIVE] You too thank you.
[AGENT][NEUTRAL] OK.