AccountId: 011433970860
ContactId: e3a520f8-2745-40d5-81e3-9eb7a7ded753
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 231889 ms
Total Talk Time (AGENT): 106925 ms
Total Talk Time (CUSTOMER): 74072 ms
Interruptions: 0
Overall Sentiment: AGENT=0.7, CUSTOMER=0.7
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/02/20/e3a520f8-2745-40d5-81e3-9eb7a7ded753_20250220T21:43_UTC.wav
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[AGENT][NEUTRAL] Thank you for calling SPL. This is. How may I help you?
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Hi, good afternoon. My name is [PII] and I'm calling with the office of Victor Smith, just checking some surgical benefits for a member.
[AGENT][POSITIVE] OK, I can help you with benefits for a patient. And um can I get your name again, please, ma'am?
[CUSTOMER][NEUTRAL] Sure. It's [PII]
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] Thank you, Ms. [PII]. And then what is your uh callback number, ma'am?
[AGENT][NEUTRAL] OK our call is disconnected?
[CUSTOMER][NEUTRAL] Sure.
[CUSTOMER][NEUTRAL] Sure. It's [PII].
[AGENT][NEUTRAL] Thank you. And then what's the patient's name, date of birth, and policy number?
[CUSTOMER][NEUTRAL] Sure. It's [PII]. The date of birth is [PII]. And the policy ID number is 01659591. And I'm sorry, what was your name?
[AGENT][NEUTRAL] OK, let
[AGENT][NEUTRAL] My name is [PII].
[CUSTOMER][POSITIVE] Thank you to.
[AGENT][POSITIVE] Thank you. I'm pulling that policy in now. Uh, I do show that uh Ms. [PII] does have an active policy.
[AGENT][NEUTRAL] And her effective date is [PII].
[CUSTOMER][NEUTRAL] And what are the policy that is?
[AGENT][NEUTRAL] And
[AGENT][POSITIVE] Ma'am, I'm sorry.
[CUSTOMER][NEUTRAL] What type of policy that is?
[AGENT][NEUTRAL] This is supplement insurance policy. It's a gap insurance that helps with deductible, co-pay, and coinsurance.
[CUSTOMER][NEUTRAL] And
[CUSTOMER][NEUTRAL] Got you. Is there any deductible that the patient has to be able to have, you know, coverage?
[AGENT][NEUTRAL] Uh, let me check and see if she has anything for surgeries that's a deductible.
[AGENT][NEUTRAL] No, she does not have a deductible.
[CUSTOMER][NEUTRAL] Is there any out of pocket?
[AGENT][NEUTRAL] No ma'am, this helps with the uh deductible copay and coinsurance, and this is just to verify her benefits. It's not a guarantee of payment. She has an inpatient calendar year benefit amount of $7900 to go towards that and then she also has an outpatient benefit amount per calendar year of.
[AGENT][NEUTRAL] The $1900.
[CUSTOMER][NEUTRAL] Did you say 10,900?
[AGENT][NEUTRAL] For acts of sickness.
[AGENT][NEUTRAL] Ma'am.
[CUSTOMER][NEUTRAL] Did you say, did you say 10,900?
[AGENT][NEUTRAL] No, 7900.
[CUSTOMER][NEUTRAL] 0 7000. Got it. Has any of it been used?
[AGENT][NEUTRAL] Let me check for you real quick.
[AGENT][NEUTRAL] No ma'am, she's not used anything for the year of [PII].
[CUSTOMER][POSITIVE] Got you, no problem. Is there any authorizations required for services at all?
[AGENT][NEUTRAL] No, because we're not the primary.
[CUSTOMER][NEUTRAL] Got you. OK. Is there a reference for a call?
[AGENT][NEUTRAL] You can use my name, it's [PII] and today's date.
[CUSTOMER][NEUTRAL] [PII]. OK, what's the first initial of your last name?
[AGENT][NEUTRAL] It is A.
[CUSTOMER][POSITIVE] OK, thank you so much for your help.
[AGENT][NEUTRAL] You're very
[AGENT][POSITIVE] You're welcome Miss [PII]. You have a good day and thanks for calling APL.
[CUSTOMER][NEUTRAL] You too. Bye-bye.
[AGENT][NEUTRAL] Bye bye.