AccountId: 011433970860
ContactId: dc01585c-e96a-4007-b2ec-24fa2af6ea0d
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 223360 ms
Total Talk Time (AGENT): 116970 ms
Total Talk Time (CUSTOMER): 80128 ms
Interruptions: 1
Overall Sentiment: AGENT=1.3, CUSTOMER=-0.4
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/01/16/dc01585c-e96a-4007-b2ec-24fa2af6ea0d_20250116T15:22_UTC.wav
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[AGENT][POSITIVE] Good morning. Thank you for calling APL. My name is [PII]. How may I help you?
[CUSTOMER][NEUTRAL] Thank you [PII]. My name is [PII]. I'm calling from the doctor's office. I need to check benefits and eligibility for a specialist office visit.
[AGENT][POSITIVE] OK. Well, I'll be more than happy to assist you with the benefits and the eligibility for the specialist office. And [PII], may I have a good contact number in case we're disconnected and the policy number?
[CUSTOMER][NEUTRAL] OK, [PII].
[AGENT][NEUTRAL] Thank you for that and the member's policy number?
[CUSTOMER][NEUTRAL] It's 02212957 ML 8.
[AGENT][NEUTRAL] Thank you for that. And can you verify the member's first and last name and date of birth?
[CUSTOMER][NEUTRAL] Yes, it's [PII] uh.
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] Thank you for that and all the information provided is a verification of benefits, not a guarantee of payment. So I am showing the policy is active. It's been effective since [PII].
[AGENT][NEUTRAL] And hold on one moment while I take a look at the benefits.
[AGENT][NEUTRAL] So for outpatient, the policy will pay up to $500 per calendar day. Um, now the policy itself doesn't have like any um in-office setting, right, but they do have the office. I'm sorry?
[CUSTOMER][NEUTRAL] Office visit.
[CUSTOMER][NEGATIVE] Uh, it's not good.
[CUSTOMER][NEGATIVE] Uh huh office visit is not covered.
[AGENT][NEUTRAL] Well, no, if I can continue, they have the office treatment rider.
[AGENT][NEUTRAL] In which the treatment in the office would be covered up to the $500 per day.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] As long as it's not cosmetic. 500.
[CUSTOMER][NEUTRAL] 200.
[CUSTOMER][NEUTRAL] $500.
[CUSTOMER][NEUTRAL] Up to listen, vasectomy.
[CUSTOMER][NEUTRAL] That is well.
[CUSTOMER][NEUTRAL] That procedure will be covered under those $500.
[AGENT][NEUTRAL] If it's an in-office procedure, as long as it's not cosmetic, yes, that office treatment rider can cover it. Now, if you charge for the facility charge and the treatment, the facility would most
[CUSTOMER][NEGATIVE] No, no, no.
[CUSTOMER][NEUTRAL] Is in office treatment mail is sterilization.
[AGENT][NEUTRAL] What I'm saying to you is facility meaning if you charge 9921399214, that's a place of service, that facility charge will not be covered because there's no office visit coverage, only the treatment in the office.
[CUSTOMER][NEUTRAL] Oh
[CUSTOMER][NEUTRAL] Only the treatment even though that the primary.
[CUSTOMER][NEUTRAL] It doesn't cover the procedure?
[AGENT][NEUTRAL] If primary does not cover the procedure, our policy cannot um be used because we're after primary.
[CUSTOMER][POSITIVE] Perfect, that's what I want to know what is your name?
[AGENT][NEUTRAL] My name is [PII] First initial to my last name is [PII].
[CUSTOMER][NEUTRAL] OK, and is, uh, can I have a reference number for this call, please?
[AGENT][NEUTRAL] Sure, sir, there's no call reference number, but you can use my name and today's date.
[CUSTOMER][POSITIVE] Thank you so much. Have a nice night. Have a nice day, please. Thank you.
[AGENT][POSITIVE] You're welcome.
[AGENT][NEUTRAL] You also
[AGENT][POSITIVE] You also, thanks for calling APL. Bye-bye.