AccountId: 011433970860
ContactId: dd00308b-1101-4f62-adba-6cb65f845a54
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 174300 ms
Total Talk Time (AGENT): 77795 ms
Total Talk Time (CUSTOMER): 65182 ms
Interruptions: 1
Overall Sentiment: AGENT=1.6, CUSTOMER=0.7
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/04/29/dd00308b-1101-4f62-adba-6cb65f845a54_20250429T13:30_UTC.wav
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[AGENT][POSITIVE] Thanks for calling APL. This is [PII]. How may I assist you?
[CUSTOMER][NEUTRAL] Hi, how are you? I'm calling to see some benefits on a patient's, uh, gap insurance.
[AGENT][POSITIVE] Sure, I can assist you with that. Can I have your name and call back number for you?
[CUSTOMER][NEUTRAL] My name is [PII]
[CUSTOMER][NEUTRAL] Callback is [PII]. What did you say your name was? I'm sorry.
[AGENT][NEUTRAL] [PII], and I didn't get to catch the spelling of your name.
[CUSTOMER][NEUTRAL] [PII]
[AGENT][POSITIVE] Thank you.
[AGENT][NEUTRAL] And what is the policy number of the member that you're calling to verify benefits for?
[CUSTOMER][NEUTRAL] The card it says.
[CUSTOMER][NEUTRAL] Only the part where it says insured coverage group effective date, so I don't know if I give you the group number.
[AGENT][NEUTRAL] So do we say cert inpatient or outpatient cert number on the card?
[CUSTOMER][NEUTRAL] Yeah, inpatient and outpatient.
[AGENT][NEUTRAL] So those are the policy numbers.
[CUSTOMER][NEUTRAL] Office so I think it's.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Um,
[CUSTOMER][NEUTRAL] Patient.
[CUSTOMER][NEUTRAL] 02295905 M as in [PII], L as in.
[CUSTOMER][NEUTRAL] Love 8.
[AGENT][NEUTRAL] Thank you, [PII]. Could you verify that patient's name and date of birth and what benefits are you inquiring about?
[CUSTOMER][POSITIVE] You're welcome.
[CUSTOMER][NEUTRAL] [PII] [PII] and it's just to see if it covers any type of co-pay for specialist office visit.
[AGENT][NEUTRAL] So this policy has been active since [PII] and it's currently active, um.
[AGENT][NEUTRAL] So it doesn't look like she has coverage for office visits. However, the treatment or the procedure received in the office is covered under her outpatient benefits and she has outpatient benefits of.
[AGENT][NEUTRAL] I'm sorry, $3500 per calendar year and this is not a guarantee of benefits just a disclaimer of the policy's coverage.
[CUSTOMER][NEUTRAL] OK, so for the office visits, like the copays for specialist office visit, it's not covered.
[AGENT][NEUTRAL] 99214, that's not covered, but the procedure if she gets any type of treatment or procedure done in the office while she's at her office visit, then that is covered under her outpatient benefit.
[CUSTOMER][POSITIVE] OK perfect.
[CUSTOMER][NEUTRAL] OK and then let me see here.
[AGENT][NEUTRAL] Is there anything else that I can assist you with today, [PII]?
[CUSTOMER][NEUTRAL] Um, no, just a reference number please.
[AGENT][NEUTRAL] We don't provide those, but you can use my name in today's date as a reference.
[CUSTOMER][POSITIVE] OK perfect thank you so much.
[AGENT][POSITIVE] You're welcome. Thanks for calling APL. Have a great day.
[CUSTOMER][NEUTRAL] Bye