AccountId: 011433970860
ContactId: dc8f2af2-c4fd-40b7-937d-98a442b7dea5
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 201039 ms
Total Talk Time (AGENT): 80027 ms
Total Talk Time (CUSTOMER): 49840 ms
Interruptions: 0
Overall Sentiment: AGENT=2.2, CUSTOMER=0.7
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/03/25/dc8f2af2-c4fd-40b7-937d-98a442b7dea5_20250325T17:55_UTC.wav
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[AGENT][NEUTRAL] Thank you for calling APL. This is [PII]. How can I help you?
[CUSTOMER][NEUTRAL] Good afternoon, [PII]. My name is [PII]. I'm calling to get benefits on a mutual patient.
[AGENT][POSITIVE] OK, [PII], I'm happy to check on benefits for you today. Can I get the patient's policy number?
[CUSTOMER][NEUTRAL] Yes, ma'am. Um,
[CUSTOMER][NEUTRAL] It would be under
[CUSTOMER][NEUTRAL] I don't know which one to give you. Outpatient benefits?
[AGENT][POSITIVE] I can pull it with either, yeah.
[CUSTOMER][NEUTRAL] 02
[CUSTOMER][NEUTRAL] OK. 02255844 M as in Mary, L as in Larry, number 8.
[AGENT][POSITIVE] Thank you for that.
[AGENT][NEUTRAL] And what is the patient's name and date of birth?
[CUSTOMER][NEUTRAL] [PII] [PII].
[AGENT][NEUTRAL] So the patient is active. The effective date on this is [PII] or the member's secondary insurance, so this would cover deductible, co-pay, co-insurance, the primary does not.
[CUSTOMER][NEUTRAL] For specialty, it covers um office visit co-pays and testing done in office.
[AGENT][NEUTRAL] Let me see if it's gonna cover the office visit fee. Some do, some don't. Let me double check on that, one moment.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Yes.
[AGENT][NEUTRAL] Mhm.
[AGENT][NEUTRAL] Alright, so it looks like this is a verification of benefits, not guarantee of payment. The patient's plan has the outpatient benefit max for the calendar year of $1000. The patient's plan does not cover the office visit fee. It does, however, cover treatment in the office.
[CUSTOMER][NEUTRAL] OK, so she's covered um for treatment as in uh but not for office visit copays.
[AGENT][NEUTRAL] Correct, it doesn't cover the office visit fee, yes ma'am.
[CUSTOMER][POSITIVE] OK, perfect.
[CUSTOMER][NEUTRAL] Can I have a confirmation number of this call?
[AGENT][NEUTRAL] Yeah, call reference is going to be my name with my last initial than today's date. My name again is [PII], which is [PII] Last initial is going to be [PII].
[CUSTOMER][POSITIVE] OK, perfect. Thank you, [PII], for your help.
[AGENT][POSITIVE] You're welcome. Have a great day.
[CUSTOMER][NEUTRAL] You too bye bye.
[AGENT][NEUTRAL] Bye bye.