AccountId: 011433970860
ContactId: d6a7e0a6-9e92-45b7-af05-d81ca53a8a8a
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 211149 ms
Total Talk Time (AGENT): 87085 ms
Total Talk Time (CUSTOMER): 77514 ms
Interruptions: 0
Overall Sentiment: AGENT=2.6, CUSTOMER=1.4
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/05/22/d6a7e0a6-9e92-45b7-af05-d81ca53a8a8a_20250522T13:44_UTC.wav
--------------------------------------------
[AGENT][POSITIVE] Good morning. Thank you for calling ATL. My name is [PII]. How can I help you?
[CUSTOMER][NEUTRAL] Hello [PII] I'm calling from a provider's office and any benefits for a member.
[AGENT][POSITIVE] OK, I can help with benefits. May I have your name?
[CUSTOMER][NEUTRAL] It's [PII], it's [PII]
[AGENT][NEUTRAL] Thank you, [PII], and may I also have your callback number?
[CUSTOMER][NEUTRAL] Oh
[CUSTOMER][NEUTRAL] [PII].
[AGENT][POSITIVE] Thank you so much, Valus. And then please may I have the policy number?
[CUSTOMER][NEUTRAL] Mhm
[CUSTOMER][NEUTRAL] It is 02549483.
[AGENT][NEUTRAL] Thank you very much, verify the patient's name and date of birth.
[CUSTOMER][NEUTRAL] It's [PII]. Last name is [PII]
[CUSTOMER][NEUTRAL] [PII].
[AGENT][POSITIVE] Thank you very much. And do you need inpatient or outpatient benefits for this member?
[CUSTOMER][NEUTRAL] Um, this is for outpatient. This is gonna be, um, for an MRI that's um gonna be done in the specialist office. Uh, I do need to know if she has uh office treatments writer on the policy.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] OK, I can assist with that information for you. Um, the policy shows effective as of [PII] shows active and for those services inside the office for diagnostic, give me one moment please.
[CUSTOMER][NEUTRAL] OK.
[AGENT][POSITIVE] Thank you.
[CUSTOMER][NEUTRAL] Well
[CUSTOMER][NEUTRAL] And.
[AGENT][POSITIVE] Thank you so much. I appreciate your patience. Please note verification of benefits provided does not guarantee payment. The member has a $6000 calendar year max. It does help with services inside the physician's office, but not the office fee.
[CUSTOMER][NEUTRAL] How can I help
[CUSTOMER][NEUTRAL] Yeah, we're not gonna bill an office visit, we're just billing for the MRI.
[AGENT][NEUTRAL] OK, um, that would be covered up to that outpatient max of $6000 of course, due to a sickness or an injury.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Now let me ask you, [PII] has um she used any of that?
[AGENT][NEUTRAL] OK, let me check that for you one moment please, Bus.
[AGENT][NEUTRAL] One moment, let me get this added up for you. I'm sorry, let me place you on a brief hold please.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][POSITIVE] Alrighty.
[AGENT][POSITIVE] Thank you.
[CUSTOMER][NEUTRAL] You're welcome. You are on hold.
[AGENT][POSITIVE] Thank you so much. Currently, $1,373.45 has been used.
[CUSTOMER][POSITIVE] Perfect. Alrighty, [PII] that'll be all. Can I get a reference number?
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] We do not use the reference numbers well because please use my name and today's date and my last initial is [PII]. Do you need any claim information submission information, or do you have that?
[CUSTOMER][POSITIVE] No, that's it thank you very much and you have a great day.
[AGENT][NEUTRAL] OK.
[AGENT][POSITIVE] You as well thank you for calling APL. Take care bye.
[CUSTOMER][POSITIVE] Thanks bye bye.