AccountId: 011433970860
ContactId: d9fa4af0-412c-4740-ac29-d8a979b79031
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 215539 ms
Total Talk Time (AGENT): 57389 ms
Total Talk Time (CUSTOMER): 63973 ms
Interruptions: 0
Overall Sentiment: AGENT=1.4, CUSTOMER=0.2
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/06/11/d9fa4af0-412c-4740-ac29-d8a979b79031_20250611T16:38_UTC.wav
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[AGENT][NEUTRAL] Calling APL, my name is [PII]. How can I assist you today?
[CUSTOMER][NEUTRAL] Hello, this is [PII] speaking from provider office. I want to know the eligibility of the member.
[AGENT][POSITIVE] I'd be happy to assist with eligibility today [PII], if I can get a good call back number for you.
[CUSTOMER][NEUTRAL] It's [PII].
[AGENT][NEUTRAL] And the policy number?
[CUSTOMER][NEUTRAL] The policy number is 01896422.
[AGENT][NEUTRAL] Patient's name and date of birth?
[CUSTOMER][NEUTRAL] Patient name is [PII] and the date of birth is
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] And the date of service?
[CUSTOMER][NEUTRAL] Uh date of
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] Thank you for that information. Please be advised the verification of coverage is not a guarantee of payment.
[AGENT][NEUTRAL] And you said [PII]?
[CUSTOMER][NEUTRAL] [PII], yes.
[AGENT][NEUTRAL] I'm not sure we have that claim on file.
[CUSTOMER][NEUTRAL] Can you try another date?
[AGENT][NEUTRAL] OK, what's the date?
[CUSTOMER][NEUTRAL] It's uh [PII].
[AGENT][NEUTRAL] [PII].
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] I'm not sure we have that claim on file.
[CUSTOMER][NEUTRAL] Actually, I want to know the eligibility of this member.
[AGENT][NEUTRAL] OK. Policy was active on that date. I'm showing that um effective date is [PII].
[AGENT][NEUTRAL] And were you calling for inpatient or outpatient benefits?
[CUSTOMER][NEUTRAL] OK
[CUSTOMER][NEUTRAL] Uh, can you repeat the effective date? June?
[AGENT][NEUTRAL] [PII].
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Uh, for outpatient.
[AGENT][POSITIVE] That's correct.
[AGENT][NEUTRAL] Showing the outpatient calendar year maximum is $2000.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] It's
[CUSTOMER][NEUTRAL] So, is there any coinsurance?
[AGENT][NEUTRAL] Um, no, that's a question for their major medical. We're the gap insurance.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] So policy is active, right?
[AGENT][POSITIVE] That's correct.
[CUSTOMER][NEUTRAL] OK. Can I have your call reference, sir?
[AGENT][NEUTRAL] Reference it's just my name [PII] last initial [PII], and the date and time of the call. Was there anything else I could assist with today?
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] [PII], last name is SSM, right?
[AGENT][POSITIVE] Correct.
[CUSTOMER][POSITIVE] OK, thank you. Have a nice day.
[AGENT][POSITIVE] Thank you for calling APL have a good day.