AccountId: 011433970860
ContactId: e3f3f08b-5ba4-49cc-90c9-e185147cdaf9
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 301510 ms
Total Talk Time (AGENT): 92992 ms
Total Talk Time (CUSTOMER): 140746 ms
Interruptions: 0
Overall Sentiment: AGENT=1.9, CUSTOMER=0.7
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/01/21/e3f3f08b-5ba4-49cc-90c9-e185147cdaf9_20250121T14:55_UTC.wav
--------------------------------------------
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] Thank you for calling APL. This is [PII]. How can I help you?
[CUSTOMER][NEUTRAL] Alright.
[CUSTOMER][NEUTRAL] Hi, yes ma'am. I have a patient who I'm just verifying his benefits.
[AGENT][NEUTRAL] Um, yes, ma'am. I can assist you with benefits. Um, first, I'll need your name and a callback number.
[CUSTOMER][NEUTRAL] [PII] [PII] no extension.
[AGENT][NEUTRAL] OK. Thank you, [PII]. Now, I need the policy number, please.
[CUSTOMER][NEUTRAL] 01909510
[AGENT][NEUTRAL] And just let me advise you the verification of coverage does not guarantee payment of claims. Could you please verify his name and date of birth?
[CUSTOMER][NEUTRAL] [PII], [PII].
[AGENT][NEUTRAL] OK, I'm showing that the effective date on this policy was [PII] and the policy is still active. And for a list of all his benefits and a breakdown and a fee schedule, I can fax that over to you.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] I say if I can get a fax copy and then if I can just give you um a few codes I just need to know what preventative services he's eligible for.
[AGENT][POSITIVE] OK, yes, ma'am. Let me get his benefits pulled up.
[CUSTOMER][NEUTRAL] Would you like for that?
[CUSTOMER][POSITIVE] No, OK, you're then thank you.
[AGENT][NEUTRAL] OK. And what is your fax number?
[CUSTOMER][NEUTRAL] [PII] no extension.
[AGENT][NEUTRAL] OK. So that's attention, [PII] [PII].
[CUSTOMER][NEUTRAL] Oh, I'm sorry, that is our phone number, not our fax number. I'm so sorry. Let me give that to you again [PII].
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] Mhm.
[AGENT][NEUTRAL] OK, [PII].
[CUSTOMER][POSITIVE] Yes ma'am, I'm so sorry about that.
[AGENT][POSITIVE] Oh, no problem, and you should receive it in about 10 minutes. I just sent it.
[CUSTOMER][NEUTRAL] OK perfect um can I check with you? I just wanna make sure that the plan is still the same from last year, um, the claims mailing address is that still [PII]?
[AGENT][POSITIVE] Yes, ma'am, that's correct.
[CUSTOMER][NEUTRAL] And the group number we have is it still 21818?
[AGENT][NEUTRAL] Let's see.
[AGENT][NEUTRAL] Yes, it is.
[CUSTOMER][NEUTRAL] And payer ID was 60801.
[AGENT][POSITIVE] Yes, that's correct.
[CUSTOMER][NEUTRAL] OK perfect and um I know we were out of network um and there was a maximum the $1500.50 dollars deductible is that still correct?
[AGENT][POSITIVE] Yes, that's correct.
[CUSTOMER][NEUTRAL] And has the patient met or used anything for this calendar year so far?
[AGENT][NEUTRAL] Let's see
[CUSTOMER][NEUTRAL] [PII] next [PII].
[AGENT][NEUTRAL] Um, no, so far, he hasn't used anything.
[CUSTOMER][NEUTRAL] [PII].
[CUSTOMER][NEUTRAL] Alright, and for coinsurance we had 18,040 for out of network, is that still correct?
[AGENT][POSITIVE] Yes, that's correct.
[CUSTOMER][NEUTRAL] And um can you tell me the history that the patient has for his preventative services?
[AGENT][NEUTRAL] Let's see.
[CUSTOMER][NEUTRAL] At this moment, um, like I said, if something falls off it's on.
[CUSTOMER][NEUTRAL] if something falls off, like I said, I'll definitely have you like give me a sticky note and keep it at my desk if anything falls off.
[CUSTOMER][NEUTRAL] checking in, yes sir.
[AGENT][POSITIVE] OK, for preventative, I'm showing it's covered up to 100%. There's no waiting period and there's no history. It's all available.
[CUSTOMER][NEUTRAL] Oh
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] Everything's available?
[AGENT][NEUTRAL] Yes, ma'am.
[CUSTOMER][NEUTRAL] All right.
[CUSTOMER][NEUTRAL] Um, can I check for his pano the 0330, um, is that still covered at 80% OK thank you thank you sir.
[AGENT][NEUTRAL] See.
[AGENT][NEUTRAL] Yes, 80%.
[CUSTOMER][NEUTRAL] OK perfect that should be all that I need if I can get your name again and the reference number.
[AGENT][NEUTRAL] Um, the reference number is my name and today's date. My name is [PII]. It's spelled [PII] Last initial is [PII], and today's date. Is there anything else that I can assist you with?
[CUSTOMER][POSITIVE] Nope, that should be all. I really appreciate it.
[AGENT][POSITIVE] OK, no problem, [PII]. Thank you for calling APL. You have a great rest of your day. Bye.
[CUSTOMER][POSITIVE] You as well thank you bye.
[AGENT][POSITIVE] Thank you.