AccountId: 011433970860
ContactId: cb5994c8-760d-437d-8be4-1b643223ebac
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 335739 ms
Total Talk Time (AGENT): 118334 ms
Total Talk Time (CUSTOMER): 34353 ms
Interruptions: 0
Overall Sentiment: AGENT=0.4, CUSTOMER=0.9
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/05/23/cb5994c8-760d-437d-8be4-1b643223ebac_20250523T20:55_UTC.wav
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[AGENT][NEUTRAL] Thank you for calling APL. This is [PII]. How can I help you?
[CUSTOMER][NEUTRAL] Hi Miss [PII], my name is [PII]. I'm calling to get eligibility and benefits on a patient.
[AGENT][NEUTRAL] I can help you with eligibility, [PII]. Can I get a good callback number in case we get disconnected?
[CUSTOMER][NEUTRAL] [PII]
[AGENT][NEUTRAL] And the policy number?
[CUSTOMER][NEUTRAL] It is 1456796.
[AGENT][NEUTRAL] Alright, let me look that up for you.
[AGENT][NEUTRAL] And can I get you to verify the patient's name and date of birth?
[CUSTOMER][NEUTRAL] [PII] [PII].
[AGENT][POSITIVE] OK. Thank you so much.
[AGENT][NEUTRAL] Right, it looks like this policy is active with an effective date of [PII].
[AGENT][NEUTRAL] This is a meddling policy, so it is secondary gap, meaning that if um the primary insurance does not cover it, this, this plan won't cover that. um and so when doing a claim for this policy, we will need the primary insurance uh explanation of benefits.
[CUSTOMER][NEUTRAL] OK
[AGENT][NEUTRAL] Did you have any specific questions regarding benefits or did you just need the eligibility?
[CUSTOMER][NEUTRAL] Outpatient, outpatient surgery, yes ma'am, outpatient surgery.
[AGENT][NEUTRAL] Let me look.
[AGENT][NEUTRAL] And just to let you know that this is just a verification of benefits and not a guarantee of payment.
[AGENT][NEUTRAL] It looks like we have an
[AGENT][NEUTRAL] Outpatient benefit maximum of up to $500 per covered person per calendar year.
[AGENT][NEUTRAL] With a $0 outpatient deductible, $0 emergency room deductible.
[CUSTOMER][NEGATIVE] Can't have anything limit on it.
[AGENT][NEUTRAL] And
[AGENT][NEUTRAL] And then it looks like for surgery in a hospital outpatient facility or freestanding outpatient surgery center.
[AGENT][NEUTRAL] Uh, it's, it's subject to a maximum of 30 days of treatment per covered person per calendar year.
[AGENT][NEUTRAL] Is there anything um more specific that you'd like me to get into?
[CUSTOMER][NEUTRAL] Um, you said it only covers up to $500.
[AGENT][NEUTRAL] Right, per person per calendar year, and that's after the primary.
[CUSTOMER][NEUTRAL] OK, has anything been meant towards that this year yet?
[AGENT][NEUTRAL] Let me check.
[CUSTOMER][POSITIVE] Bless you.
[AGENT][NEUTRAL] Mm, give me just a second.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] Right, I'm showing that she hasn't used anything to date this year.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Can I get a reference number please?
[AGENT][NEUTRAL] So we don't have reference numbers, but you can use my name and last initial in today's date. So [PII], in today's date.
[CUSTOMER][POSITIVE] Thank you, you have a good day.
[AGENT][POSITIVE] Thank you for calling [PII] have a great great day and thank you for calling APL.
[CUSTOMER][POSITIVE] Thank you.
[AGENT][NEUTRAL] Bye.