AccountId: 011433970860
ContactId: e6d831dc-301e-4e32-b99a-36567e214696
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 183589 ms
Total Talk Time (AGENT): 89451 ms
Total Talk Time (CUSTOMER): 31807 ms
Interruptions: 0
Overall Sentiment: AGENT=1.4, CUSTOMER=2
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/06/02/e6d831dc-301e-4e32-b99a-36567e214696_20250602T21:09_UTC.wav
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[AGENT][NEUTRAL] Thank you for calling APL. This is [PII]. How can I help you?
[CUSTOMER][NEUTRAL] Hi, [PII]. My name is [PII]. I'm calling from Mount Sinai Medical Center. I need to verify coverage please for one member.
[AGENT][POSITIVE] Sure, I can help you with coverage. Um, can I, can I get where you're calling from again? I'm so sorry.
[CUSTOMER][NEUTRAL] Sure, Mount Sinai Medical Center.
[AGENT][NEUTRAL] And can I get a good callback number in case we get disconnected?
[CUSTOMER][NEUTRAL] Area code [PII].
[AGENT][POSITIVE] OK, thank you so much.
[AGENT][NEUTRAL] And what's the policy number?
[CUSTOMER][NEUTRAL] Policy number I have is 02481568.
[AGENT][NEUTRAL] OK, give me one moment while I look that up.
[CUSTOMER][NEUTRAL] Of course.
[AGENT][NEUTRAL] And can you verify the patient's name and date of birth for me, please?
[CUSTOMER][NEUTRAL] Station is [PII] [PII].
[AGENT][POSITIVE] OK, thank you so much.
[AGENT][NEUTRAL] I'm showing that this is an active policy with an effective date of [PII]. This is a meddling policy. It is secondary gap insurance. Uh, so when filing a claim, we will need the primary insurance EOB or explanation of benefits included with the claim documents.
[AGENT][NEUTRAL] Were there anything, was there anything specific you needed?
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Outpatient diagnostic services members coming in for an MRI.
[AGENT][NEUTRAL] OK, let me look that up.
[CUSTOMER][POSITIVE] Thank you.
[AGENT][POSITIVE] And this policy does help with co-pay, co-deductible and co-insurance. I just wanna let you know that as well.
[AGENT][NEUTRAL] And let's see. You said outpatient diagnostics.
[CUSTOMER][POSITIVE] Thank you.
[CUSTOMER][NEUTRAL] Yes.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] And this is just a verification of benefits and not a guarantee of payment. It looks like [PII] has an outpatient benefit maximum of up to $3000 per calendar year with a $0 deductible per calendar year for outpatient services or emergency room.
[AGENT][NEUTRAL] Uh, he is allotted diagnostic testing in a hospital. It is subject to a maximum of 30 days of treatment per covered person per calendar year.
[CUSTOMER][POSITIVE] OK. Thank you so much and you have a wonderful day.
[AGENT][POSITIVE] Great, thank you for calling APL and if there's nothing else, I hope you have a great day.
[CUSTOMER][POSITIVE] Thank you. Bye-bye.
[AGENT][NEUTRAL] Alright bye.