AccountId: 011433970860
ContactId: cc8d7cd7-1688-4116-8fc7-28d6f49a7752
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 229490 ms
Total Talk Time (AGENT): 93510 ms
Total Talk Time (CUSTOMER): 71979 ms
Interruptions: 0
Overall Sentiment: AGENT=1.7, CUSTOMER=1.5
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/06/19/cc8d7cd7-1688-4116-8fc7-28d6f49a7752_20250619T15:56_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] Hi, [PII]. I'm calling to verify benefits for one of your members.
[AGENT][POSITIVE] OK, well I can help you with the benefits. May I have your name?
[CUSTOMER][NEUTRAL] [PII], initial [PII].
[AGENT][NEUTRAL] All right, [PII], may I have a good contact number in case we're disconnected and the policy number?
[CUSTOMER][NEUTRAL] Contact number is [PII].
[CUSTOMER][NEUTRAL] And the policy number is 025793992.
[AGENT][NEUTRAL] Thank you, hold on one moment.
[AGENT][NEUTRAL] And can you verify the member's first and last name and date of birth?
[CUSTOMER][NEUTRAL] [PII] [PII].
[AGENT][NEUTRAL] Thank you for that and all the information provided is a verification of benefits, not a guarantee of payment, and I am showing the policy is active. It's been effective since [PII].
[AGENT][NEUTRAL] And what type of benefits did you want to go over today?
[CUSTOMER][NEUTRAL] Uh, patient is having outpatient hospital surgery.
[AGENT][NEUTRAL] Alright, so for outpatient, the policy would pay up to $500 per calendar day.
[CUSTOMER][NEUTRAL] Meaning per calendar day of how much has accumulated in the year.
[AGENT][NEUTRAL] No, $500 per calendar day, $500 each day.
[AGENT][NEGATIVE] So it like resets each day and they have $500 to use.
[CUSTOMER][NEUTRAL] For out
[CUSTOMER][NEUTRAL] OK, so it's outpatient hospital, so it's a $500 benefit.
[AGENT][NEUTRAL] Yes.
[AGENT][NEUTRAL] $500 per calendar day and that does include um surgery in a hospital outpatient facility or outstanding um hospital surgery center.
[CUSTOMER][NEUTRAL] OK. It doesn't cover her deductible or anything like that?
[AGENT][NEUTRAL] I mean, well, the policy pays towards the deductible, co-pay, and co-insurance after primary, just up to that $500 per day.
[CUSTOMER][NEUTRAL] OK, it's the per day part that's that's throwing me off, so she's an outpatient, so it's just gonna be one day, so it's just $500.
[AGENT][NEUTRAL] Right, so I'm just
[AGENT][NEUTRAL] Yes, I'm just giving you the benefits in general. So it some are per calendar year, this one is per day, so whatever day her surgery is, she has $500 to use.
[CUSTOMER][NEUTRAL] OK. And her other medical, there's a $5000 deductible. Nothing goes toward this except the $500.
[AGENT][NEUTRAL] Right, correct. That's the max that we would pay for outpatient expenses.
[CUSTOMER][NEUTRAL] Uh
[CUSTOMER][NEUTRAL] OK. And [PII], what is, uh, what is our call reference?
[AGENT][NEUTRAL] So there's no call reference number, but you can use my name in today's date. The first initial to my last name is [PII].
[CUSTOMER][POSITIVE] OK. Thank you so much. I appreciate your help.
[AGENT][POSITIVE] You're very welcome. Was there anything else I can assist you with today?
[CUSTOMER][POSITIVE] Uh, no, ma'am. Thank you. That, that was everything I needed.
[AGENT][POSITIVE] All right. Well, thanks so much for calling APL. I hope you have a good day.
[CUSTOMER][POSITIVE] You too. Thank you. Bye-bye.
[AGENT][POSITIVE] You're welcome. Bye bye.