AccountId: 011433970860
ContactId: e5742a33-1140-4672-a004-1dee035b9c8a
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 181899 ms
Total Talk Time (AGENT): 80808 ms
Total Talk Time (CUSTOMER): 67429 ms
Interruptions: 1
Overall Sentiment: AGENT=1.4, CUSTOMER=0.3
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/03/11/e5742a33-1140-4672-a004-1dee035b9c8a_20250311T20:27_UTC.wav
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[AGENT][NEUTRAL] AP, this is [PII]. How may I assist you?
[CUSTOMER][NEUTRAL] Hi, yes, I have a patient that's coming in for uh tomorrow, and he just called saying that he has gap insurance and I'm trying to get benefits, um, for his outpatient procedure.
[AGENT][POSITIVE] Sure, I can assist you today. Can I have your name and a callback number?
[CUSTOMER][NEUTRAL] Sure, my name is [PII]
[CUSTOMER][NEUTRAL] Callback number is [PII].
[AGENT][NEUTRAL] [PII], thank you. What is the policy number of the member that you're inquiring eligibility for?
[CUSTOMER][NEUTRAL] Um, what he gave me was 02593359 M as in Mary, L as in Luke, and the last number is 8.
[AGENT][NEUTRAL] Can you verify that patient's name and date of birth?
[CUSTOMER][NEUTRAL] It's [PII]. Date of birth is [PII].
[AGENT][POSITIVE] Thank you.
[AGENT][NEUTRAL] This policy has been active since [PII] and it's currently at the [PII]. The member has a maximum benefit amount.
[AGENT][NEUTRAL] Of $500 per calendar day and this is his outpatient benefit which his office, the treatment received in the office is falls on the day benefit amount.
[AGENT][NEUTRAL] In his lab rider. Unfortunately, the office visit itself is not covered, but the treatment received in the office is covered, so I'm not sure if the place of service is an office visit or if it's an actual outpatient procedure.
[CUSTOMER][NEUTRAL] Yeah, we're uh ambulatory surgical center so we would be considered as um outpatient procedure um mhm.
[AGENT][NEUTRAL] Outpatient surgery center. So his outpatient benefits of $500 per calendar day and this is not a guaranteed beneficial just a disclaimer of the policy's coverage.
[CUSTOMER][NEUTRAL] If
[CUSTOMER][NEUTRAL] OK, so he's only covered $500 pretty much.
[AGENT][NEUTRAL] Per calendar day.
[CUSTOMER][NEUTRAL] Per calendar day. OK, well, he, well, yeah, so it would only be $500 because we're not impatient, he's leaving the same day.
[AGENT][NEUTRAL] No outpatients, yeah, OK, so his inpatient benefits is completely different from his outpatient benefits.
[CUSTOMER][NEUTRAL] Right, but since we're outpatient, he would still be, he would only have $500 coverage, correct?
[AGENT][POSITIVE] Yes, that is correct per calendar day. Yes, that is correct.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Alright
[CUSTOMER][NEUTRAL] All right, can I just get a reference number of the call?
[AGENT][NEUTRAL] [PII], we don't provide those unfortunately. However, you can feel free to use my name and today's date as a reference is [PII] and today's date as a reference. Is there anything else that I can assist you with today?
[CUSTOMER][POSITIVE] No, that's it thank you.
[AGENT][POSITIVE] Thanks for calling APL. Have a great day, [PII].
[CUSTOMER][NEUTRAL] You too bye bye.