AccountId: 011433970860
ContactId: d7ab71a3-c09f-4ab9-bb66-9a291f3aded9
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 266799 ms
Total Talk Time (AGENT): 128692 ms
Total Talk Time (CUSTOMER): 87025 ms
Interruptions: 0
Overall Sentiment: AGENT=1.2, CUSTOMER=0.9
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/01/14/d7ab71a3-c09f-4ab9-bb66-9a291f3aded9_20250114T16:06_UTC.wav
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[AGENT][NEUTRAL] Thank you for calling APL. This is [PII]. How can I help you?
[CUSTOMER][POSITIVE] Uh yes, I'm calling for eligibility and benefits for the patient.
[AGENT][NEUTRAL] OK, may I have your name? I can help you.
[CUSTOMER][NEUTRAL] Yes, that's [PII].
[AGENT][NEUTRAL] OK, and I'm sorry, can you spell that for me?
[CUSTOMER][NEUTRAL] Uh yes, it's [PII]
[AGENT][NEUTRAL] OK, thank you [PII] and may I also have your callback number if we are disconnected please?
[CUSTOMER][NEUTRAL] It would be [PII].
[AGENT][NEUTRAL] Thank you and may I have the policy number please?
[CUSTOMER][NEUTRAL] Yes, I have 126.
[CUSTOMER][NEUTRAL] 0231.
[AGENT][POSITIVE] OK, thank you so much. Let me just repeat that to you. I have that as 1260231. Thank you.
[CUSTOMER][NEUTRAL] Yes.
[AGENT][NEUTRAL] And verify the patient's name and date of birth please.
[CUSTOMER][NEUTRAL] Um, it's for [PII]. Uh the last name is [PII], and it's [PII].
[AGENT][POSITIVE] OK, thank you very much for the information, [PII] and again you're calling for eligibility and benefits. I can help you with that.
[AGENT][NEUTRAL] Give me 1 2nd, please.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] OK, thank you so much for your patience. Um, it shows effective as of [PII], and this policy shows that it termed as of July, excuse me, [PII]. If you would just bear with me, let me just check to see if there is an active policy for the member, please. One moment.
[CUSTOMER][NEUTRAL] OK.
[AGENT][POSITIVE] OK I appreciate your patience. I was able to locate an active policy. Let me provide that to you when you're ready.
[CUSTOMER][POSITIVE] OK, I'm ready.
[AGENT][NEUTRAL] OK, it is 257-8805.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] And this policy shows an effective date of [PII] and it shows that it's currently active.
[AGENT][NEUTRAL] And what benefit would you need please for the member?
[CUSTOMER][NEUTRAL] Um, uh, she's coming in for like outpatient surgery.
[AGENT][NEUTRAL] OK, will this be done in a facility or an office visit setting?
[CUSTOMER][NEUTRAL] Um, it'll be done in the facility.
[AGENT][NEUTRAL] OK, please note verification of benefits provided does not guarantee payment. We pay up to $4000 for the calendar year for covered services. She does have a deductible of $100 to meet prior to.
[CUSTOMER][NEUTRAL] OK
[CUSTOMER][NEUTRAL] And I'm assuming it's not been met yet, correct?
[AGENT][POSITIVE] Yes, yes, that is correct.
[CUSTOMER][NEUTRAL] OK
[CUSTOMER][NEUTRAL] And then um do y'all cover if she comes in for a specialist office visit or is the.
[AGENT][NEUTRAL] The plan
[AGENT][NEUTRAL] Uh, no, it does not cover for an office visit fee. Let me just check to see if she has maybe a benefit to cover maybe services inside the office. Give me one moment.
[CUSTOMER][NEUTRAL] OK.
[AGENT][POSITIVE] Thank you. Um, she does have a benefit to cover, to help cover with covered services inside the doctor's office, and that falls under the outpatient max of $4000.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] And um for the new plan, does it have a new ID number? I mean a group number for billing purposes?
[AGENT][NEUTRAL] Let me just check to see that please one moment I'll get that for you.
[AGENT][NEUTRAL] The group number shows 14871.
[CUSTOMER][NEUTRAL] OK
[CUSTOMER][NEUTRAL] And um would the address be the same as the [PII]?
[AGENT][NEUTRAL] Yes.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] And I believe that is all I needed then um do you do reference numbers or anything?
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] We do not, but please you can use my name [PII]. My last initial is [PII], and today's date.
[CUSTOMER][POSITIVE] OK, and thank you so much.
[AGENT][POSITIVE] You're very welcome and thank you for calling APL. Take care bye.
[CUSTOMER][POSITIVE] Thank you you too bye.