AccountId: 011433970860
ContactId: d4f63132-2f77-4b7e-9956-144f8dada6b4
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 180240 ms
Total Talk Time (AGENT): 73019 ms
Total Talk Time (CUSTOMER): 52911 ms
Interruptions: 0
Overall Sentiment: AGENT=0.6, CUSTOMER=1.8
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/03/26/d4f63132-2f77-4b7e-9956-144f8dada6b4_20250326T14:07_UTC.wav
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[AGENT][NEUTRAL] Good morning. Thank you for calling APL. This is [PII]. May I help you?
[CUSTOMER][NEUTRAL] Good morning [PII]. My name is [PII]. I'm calling from a provider's office. I need uh eligibility and benefits, please.
[AGENT][NEUTRAL] OK, [PII], do you have a callback number I can get?
[CUSTOMER][NEUTRAL] Yes, [PII].
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] And do you have the policy number?
[CUSTOMER][NEUTRAL] 02477114.
[AGENT][NEUTRAL] Thank you, [PII]. Hold on one moment, please.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] And was the patient's name?
[CUSTOMER][NEUTRAL] That will be [PII].
[AGENT][NEUTRAL] And the date of birth.
[CUSTOMER][NEUTRAL] His date of birth is [PII].
[AGENT][NEUTRAL] Thank you, [PII], and were you needing benefits or claim status?
[CUSTOMER][POSITIVE] Benefits for outpatient surgery.
[AGENT][NEUTRAL] OK, I can help you with that. Hold on one moment, please.
[CUSTOMER][POSITIVE] Thank you.
[AGENT][NEUTRAL] OK. When is he having the surgery?
[CUSTOMER][NEUTRAL] Um, let me see, I think it's tomorrow. Yes, tomorrow, outpatient and ambulatory surgical center.
[AGENT][NEUTRAL] OK, hold on one moment.
[AGENT][NEUTRAL] So he's having it on [PII].
[CUSTOMER][NEUTRAL] Yes.
[AGENT][NEUTRAL] OK, the effective date is [PII].
[AGENT][NEUTRAL] Any benefits given over the phone is not a guarantee of payment?
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] This policy coordinates with the primary insurance, whatever the primary applies to their deductible co-pay or co-insurance.
[AGENT][NEUTRAL] For outpatient.
[AGENT][NEUTRAL] Hold on one moment.
[AGENT][NEUTRAL] We'll pay up to $7000.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] If there was something to happen and he didn't have it tomorrow, this policy cancels for 1 of 25.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] And out of those 7000, has he exhausted anything or?
[AGENT][NEUTRAL] Let me check and see.
[AGENT][NEUTRAL] No, ma'am. He has not used anything.
[CUSTOMER][NEUTRAL] Mhm
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] So as long as it's outpatient $7000 is available so far, OK.
[AGENT][NEUTRAL] Right. Mhm.
[CUSTOMER][POSITIVE] OK, I'll let the member know then thank you, [PII].
[AGENT][NEUTRAL] Is there anything else I can help you with?
[CUSTOMER][POSITIVE] That's all thank you very much.
[AGENT][POSITIVE] Thank you, [PII], for calling APL. You have a good day.
[CUSTOMER][POSITIVE] You too bye bye thank you.
[AGENT][POSITIVE] Thank you. Bye-bye.