AccountId: 011433970860
ContactId: e7394006-4e7a-435c-901b-a908a435524b
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 318070 ms
Total Talk Time (AGENT): 110954 ms
Total Talk Time (CUSTOMER): 86081 ms
Interruptions: 0
Overall Sentiment: AGENT=0.7, CUSTOMER=0.4
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/04/03/e7394006-4e7a-435c-901b-a908a435524b_20250403T14:38_UTC.wav
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[AGENT][NEUTRAL] Thank you for calling APL. This is [PII]. How may I help you?
[CUSTOMER][NEUTRAL] Uh, hi, my name is [PII] from provider's office checking on members eligibility and benefits.
[AGENT][NEUTRAL] OK, [PII], I can help you with eligibility and benefits. Can I please get your callback number?
[CUSTOMER][NEUTRAL] Yeah, before the callback number, could you please spell me your name?
[AGENT][NEUTRAL] It's [PII]
[CUSTOMER][NEUTRAL] Thank you, ma'am. The callback number [PII].
[AGENT][NEUTRAL] Did you get that? It's [PII]
[CUSTOMER][NEUTRAL] Yeah, I got that.
[AGENT][NEUTRAL] OK and what is number sir?
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] Thank you and what is the name of the facility you're calling from?
[CUSTOMER][NEUTRAL] Richmond Gastroenterology Associates.
[AGENT][NEUTRAL] OK, and can you please give me the patient's name, date of birth, and policy number?
[CUSTOMER][NEUTRAL] Patient's name would be, the policy number first would be 02287616. Patient's name, [PII].
[CUSTOMER][NEUTRAL] On [PII].
[AGENT][NEUTRAL] I'm sorry, I'm having a hard time hearing you. Can you repeat that policy number one more time?
[CUSTOMER][NEUTRAL] Uh, the policy number would be 02287616.
[AGENT][NEUTRAL] And what was the last digit 022876?
[CUSTOMER][NEUTRAL] Yeah, 228-761-6.
[AGENT][POSITIVE] OK, thank you so much I appreciate that.
[AGENT][NEUTRAL] OK, I do show that [PII] does have an active policy. Her effective date is [PII].
[AGENT][NEUTRAL] And this is just to verify benefits. It's not a guarantee of payment. She has a supplemental insurance policy that's billed secondary to the primary. It helps with deductible, co-pay, and co-insurance. She has an inpatient benefit amount per calendar year of $1500 and then she also has an outpatient calendar year benefit of $1500.
[CUSTOMER][NEUTRAL] Uh, uh, that's 1500 is of deductible, right?
[AGENT][NEUTRAL] 1500 is the benefit that goes towards deductible, co-pay or co-insurance.
[CUSTOMER][NEUTRAL] OK
[CUSTOMER][NEUTRAL] OK. Any accumulations out of that?
[AGENT][NEUTRAL] I'm sorry, can you repeat the question?
[CUSTOMER][NEUTRAL] Uh, I mean, did she make anything out of that $1500?
[AGENT][NEUTRAL] Let me look for you real quick sir.
[CUSTOMER][NEUTRAL] Yeah.
[AGENT][NEGATIVE] Nothing has been used for the year of [PII].
[CUSTOMER][NEUTRAL] Uh, what about any co-pay, co-insurance?
[AGENT][NEUTRAL] [PII].
[AGENT][NEUTRAL] Are you there sir?
[CUSTOMER][NEUTRAL] Yeah, uh, uh, what about any co-pay? Yes, I'm there. Uh, what about any co-pay, coinsurance, and out of pocket for the ma'am?
[AGENT][POSITIVE] Oh, I'm sorry.
[AGENT][NEUTRAL] Uh, there's no copay, co-insurance, or out of pocket.
[CUSTOMER][NEUTRAL] Only the maximum amount of $1500 right?
[AGENT][NEUTRAL] Yes.
[CUSTOMER][NEUTRAL] And what about the codes and any, I mean, uh, this services required any authorizations I have the codes.
[AGENT][NEUTRAL] No, this is a secondary insurance, not the major medical, so the, no authorization is needed.
[CUSTOMER][NEUTRAL] Thank you, ma'am. Can I get the reference number?
[AGENT][NEUTRAL] Yes sir, you can use my name [PII] and today's date.
[CUSTOMER][POSITIVE] Thank you, ma'am. You have a great day.
[AGENT][POSITIVE] You too [PII]. Is there anything else I can help you with before we go?
[CUSTOMER][NEUTRAL] I think that's that's it for today.
[AGENT][POSITIVE] OK, have a good day and thank you for calling APL.
[CUSTOMER][POSITIVE] Thank you, take care. Bye-bye.
[AGENT][NEUTRAL] Bye-bye.