AccountId: 011433970860
ContactId: db611068-7a5f-404d-a14a-41435b24319b
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 184130 ms
Total Talk Time (AGENT): 94937 ms
Total Talk Time (CUSTOMER): 56482 ms
Interruptions: 0
Overall Sentiment: AGENT=2.8, CUSTOMER=0.8
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/01/13/db611068-7a5f-404d-a14a-41435b24319b_20250113T18:32_UTC.wav
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[AGENT][NEUTRAL] Hi, thank you for calling APL. This is [PII]. How can I help you today?
[CUSTOMER][NEUTRAL] Hi, [PII]. My name is [PII], and you spell your name [PII] or a different way?
[AGENT][POSITIVE] Oh, it's [PII] Thank you for asking, Ms. [PII]. And how can I help you today?
[CUSTOMER][POSITIVE] Thank you.
[CUSTOMER][NEUTRAL] I'm wanting to see if some members active and what their outpatient benefits are.
[AGENT][POSITIVE] OK, yeah, I'd love to help you with some eligibility and benefits today and may I have a good call back number?
[CUSTOMER][NEUTRAL] [PII]
[AGENT][POSITIVE] Wonderful, thank you, and then the member's policy number please?
[CUSTOMER][NEUTRAL] 825.
[CUSTOMER][NEUTRAL] Uh, let me see. Card says, uh,
[CUSTOMER][NEUTRAL] Alright, where is it? Outpatient, 02255658.
[AGENT][POSITIVE] Wonderful. And give me just.
[CUSTOMER][NEUTRAL] [PII]
[CUSTOMER][NEUTRAL] Lima 8.
[AGENT][POSITIVE] OK, perfect, thank you.
[AGENT][NEUTRAL] And would you be able to verify for me pretty please the patient's first and last name and date of birth?
[CUSTOMER][NEUTRAL] It's [PII].
[CUSTOMER][NEUTRAL] And date of birth is [PII].
[AGENT][NEUTRAL] Mhm.
[AGENT][POSITIVE] Perfect thank you and.
[AGENT][NEUTRAL] Your patient is current and active. It looks like they have an effective date of bless you, um, of [PII]. And let me pull up those outpatient benefits for you. I do want to let you know though any benefit information I give you over the phone is just a verification of coverage and a guarantee of payment.
[CUSTOMER][NEUTRAL] Excuse me.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] Sorry that screen's just loading. All right, so it looks like we have.
[AGENT][NEUTRAL] An outpatient calendar year maximum of $1000.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] And
[AGENT][NEUTRAL] Um, do you know if
[AGENT][NEUTRAL] Is it for an ER?
[CUSTOMER][NEUTRAL] No it's for an outpatient, uh, visit. Uh, he's gonna have an MRI done.
[AGENT][NEUTRAL] Is it
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] No worries, I just, they do have a deductible in the ER, but they don't have any deductible otherwise.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] OK.
[AGENT][POSITIVE] Perfect. And is there any other information I can help you with today, my friend?
[CUSTOMER][NEUTRAL] Uh, the remaining would be the 1000.
[AGENT][NEUTRAL] Um, that's their benefits. Let me see if they've used anything so far for this calendar year.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] 5658.
[AGENT][NEUTRAL] I'm not showing any um claims submitted for the [PII] calendar year yet.
[CUSTOMER][POSITIVE] OK awesome. Is there a reference number to this call?
[AGENT][POSITIVE] Oh yes, absolutely. It's gonna be my name, [PII], first initial last name, [PII], and today's date.
[CUSTOMER][POSITIVE] OK dokey. Thank you so much. Have a good day.
[AGENT][POSITIVE] Hey, it's my pleasure, Ms. [PII]. Thanks for calling APL and you take care.
[CUSTOMER][NEUTRAL] Bye.
[AGENT][NEUTRAL] Bye.