AccountId: 011433970860
ContactId: d2be1386-345f-435b-8d7a-26de0762bab9
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 259350 ms
Total Talk Time (AGENT): 110533 ms
Total Talk Time (CUSTOMER): 72643 ms
Interruptions: 0
Overall Sentiment: AGENT=1.3, CUSTOMER=0.6
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/03/28/d2be1386-345f-435b-8d7a-26de0762bab9_20250328T16:57_UTC.wav
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[AGENT][NEUTRAL] Thank you for calling APL. This is [PII]. How can I help you?
[CUSTOMER][NEUTRAL] Oh hello [PII]. Uh, would you like to check for benefits for this member?
[AGENT][POSITIVE] OK. Happy to check on benefits for you today. Do you have the patient's policy number?
[CUSTOMER][NEUTRAL] Yes, I have. It is 02342994 ML 8.
[AGENT][POSITIVE] Thank you. And if I could get your first name and a callback number?
[CUSTOMER][NEUTRAL] Sure. This is [PII]. Number is [PII] [PII].
[AGENT][NEUTRAL] Thank you, [PII] and then patient's name and date of birth?
[CUSTOMER][NEUTRAL] [PII], [PII].
[AGENT][NEUTRAL] All right, [PII], uh, let me repeat this number. The phone was kind of breaking up. I may have missed a number. I copied down 02.
[AGENT][NEUTRAL] 34.
[AGENT][NEUTRAL] 6994.
[CUSTOMER][NEUTRAL] Um, that is 02342994 ML8.
[AGENT][NEUTRAL] OK, so it's a 2994, correct?
[CUSTOMER][POSITIVE] Yes, correct.
[AGENT][NEUTRAL] And it was for [PII]?
[CUSTOMER][NEUTRAL] Uh-huh.
[AGENT][NEUTRAL] OK. So, patient is active. The effective date is [PII]. We are the members secondary insurance, so this is gonna cover deductible, co-pay, co-insurance, the primary does not.
[CUSTOMER][NEUTRAL] OK. Um, may we know, [PII], if the diagnostic and the surgery in the office will be covered?
[AGENT][NEUTRAL] Uh, let me see one moment.
[AGENT][NEUTRAL] Uh, this is a verification of benefits, not guarantee of payment. Uh, looks like the patient plan has the outpatient benefit max of $500 and that's per calendar day. That would include any sort of surgery.
[CUSTOMER][NEUTRAL] Include surgery. How about for the diagnostic or for labs?
[AGENT][NEUTRAL] Let me see if there's any lab or diagnostic. One moment.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] It looks like diagnostic testing would also fall under the outpatient benefits, and so that would be again a max of $500 per calendar day.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK, um, does it also have the maximum outpatient benefits for the whole calendar year or that's only for per day basis?
[AGENT][NEUTRAL] Uh, this patient plan is per calendar day. There is no calendar year for outpatient.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] And that's 500 per calendar day, correct?
[AGENT][POSITIVE] That is correct, yes, ma'am.
[CUSTOMER][NEUTRAL] All right, perfect. [PII], can I request for a call reference number?
[AGENT][NEUTRAL] Absolutely. Call reference is my name with my last initial, then today's date. My name again is [PII], that's [PII] Last [PII] is [PII] and then today's date.
[CUSTOMER][POSITIVE] Alrighty thank you so much for your help, [PII].
[AGENT][POSITIVE] You're welcome. Have a good day, [PII].
[CUSTOMER][NEUTRAL] Likewise. Bye-bye.