AccountId: 011433970860
ContactId: ce57b772-9abf-42a9-a347-b08f10c1ac3b
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 159529 ms
Total Talk Time (AGENT): 61998 ms
Total Talk Time (CUSTOMER): 76881 ms
Interruptions: 0
Overall Sentiment: AGENT=1.2, CUSTOMER=1
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/05/06/ce57b772-9abf-42a9-a347-b08f10c1ac3b_20250506T19:33_UTC.wav
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[AGENT][NEUTRAL] For calling APL, my name is [PII]. How can I assist you today?
[CUSTOMER][NEUTRAL] Hi [PII], my name is [PII] and I'm trying to get outpatient benefits for a member.
[AGENT][POSITIVE] I'd be happy to assist with benefits today [PII] if I can get a good call back number for you.
[CUSTOMER][NEUTRAL] Sure, it is [PII].
[AGENT][NEUTRAL] And what is the policy number?
[CUSTOMER][NEUTRAL] And the policy number we have is 02467409ML8.
[AGENT][NEUTRAL] Patient's name and date of birth?
[CUSTOMER][NEUTRAL] Is [PII]. Her date of birth is [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 [PII]. And are you calling for inpatient or outpatient benefits?
[CUSTOMER][NEUTRAL] Outpatient.
[AGENT][NEUTRAL] They do show the per day maximum for outpatient is $250.
[CUSTOMER][NEUTRAL] Per day?
[AGENT][NEUTRAL] Yes, per day.
[CUSTOMER][POSITIVE] OK, perfect, OK.
[CUSTOMER][NEUTRAL] OK, so now, and that now also, would that be per claim per day? Because um I know that the patient is having an outpatient surgical procedure which um um the facility is also gonna submit that day for um um a claim and also the doctor.
[AGENT][POSITIVE] May the best billing office win. It's first come, first served.
[CUSTOMER][NEUTRAL] So, let's say.
[CUSTOMER][NEUTRAL] For, OK, so now let's say an example, basically, um, our charges is like 50 something, so their charges is about 50 something too. So it'll matter if she got the 250, whether it's the separate claims, right?
[AGENT][NEUTRAL] We're only paying a maximum of $250 and we're gonna pay whoever claimed whoever files first. So if whoever files first doesn't take up that $250 and there's some left, like say we get one claim and we only have to pay $100 then she has $150 left for that day and then we'll process the second claim.
[CUSTOMER][NEUTRAL] Oh, OK.
[CUSTOMER][POSITIVE] Awesome, OK, yeah, that's what I wanted to kind of clarify, OK.
[CUSTOMER][NEUTRAL] All right, thank you so much then [PII]. Can I get a reference card number and the first initial to your last?
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] Um, rough is just my name [PII], last initial [PII], and the date and time of the call. Was there anything else I can assist with today?
[CUSTOMER][POSITIVE] No, that will be all thank you.
[AGENT][POSITIVE] Thank you for calling APO you have a good day.
[CUSTOMER][NEUTRAL] You too bye bye now.
[AGENT][NEUTRAL] Bye bye.