AccountId: 011433970860
ContactId: e798f5c9-4349-4240-b517-bf1d71a65119
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 282920 ms
Total Talk Time (AGENT): 117168 ms
Total Talk Time (CUSTOMER): 104087 ms
Interruptions: 1
Overall Sentiment: AGENT=0.7, CUSTOMER=1.6
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/06/26/e798f5c9-4349-4240-b517-bf1d71a65119_20250626T15:04_UTC.wav
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[AGENT][NEUTRAL] Calling APL. This is [PII]. How may I assist you?
[CUSTOMER][NEUTRAL] Hi, yes, I'm calling for benefits and eligibility please for our patient.
[AGENT][POSITIVE] Sure, I can assist you with that. Can I have your name and a callback number?
[CUSTOMER][NEUTRAL] Yes, of course. It's gonna be [PII] A.
[CUSTOMER][NEUTRAL] And the best callback number is gonna be [PII].
[AGENT][NEUTRAL] Thank you, [PII]. Can I have that policy number, the member that you're calling to verify eligibility for today?
[CUSTOMER][NEUTRAL] You're
[CUSTOMER][POSITIVE] Yes, of course, it's gonna be for the patient to have a year.
[CUSTOMER][NEUTRAL] Oh sorry, but sorry, the member ID is 023.
[CUSTOMER][NEUTRAL] 00110 M as in Mike L as in Lima 8
[AGENT][NEUTRAL] Thank you and what is the member's name and date of birth, [PII]?
[CUSTOMER][NEUTRAL] [PII].
[CUSTOMER][NEUTRAL] And the date of birth I can give you it right now. Give me one moment.
[AGENT][POSITIVE] Sure, take your time.
[CUSTOMER][NEUTRAL] Right.
[CUSTOMER][NEUTRAL] It's gonna be
[CUSTOMER][NEUTRAL] [PII]
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] [PII], you're calling to verify benefits eligibility for what place of service?
[CUSTOMER][NEUTRAL] For an office visit and outpatient surgery, if there's any benefits.
[AGENT][NEUTRAL] This member's policy.
[AGENT][NEUTRAL] Thank you. This member's policy has been active since [PII] and it's currently active. The member has outpatient benefits of $7900 per calendar year, and this is not a guarantee of benefits, just a disclaimer of the policy's coverage. And the member also has an office treatment rider which pays up to $25 per visit if it's a regular office visit, however, if it's a specialist, it pays up to $50 per visit.
[AGENT][NEGATIVE] 4 visits per calendar year and this is not a guaranteed benefit a disclaimer of the policy's coverage.
[CUSTOMER][NEUTRAL] OK, so for specialists, it's $50 per visit and it's 4 visits and for outpatient.
[CUSTOMER][NEUTRAL] Um, if the plan pays up to 7900 per calendar year, yes?
[AGENT][POSITIVE] Yes, that is correct.
[CUSTOMER][NEUTRAL] And how much has been accumulated for the calendar year and how many visits have been used, please?
[AGENT][NEUTRAL] $60. No office visits has been accumulated and $60 has been utilized out of the outpatient benefits.
[CUSTOMER][POSITIVE] Perfect.
[CUSTOMER][NEUTRAL] Perfect. I have another patient if you're able to assist me, but before that, are you able to provide a reference number please?
[AGENT][NEUTRAL] We don't provide those. You can use my name in today's date as a reference. It's [PII].
[CUSTOMER][POSITIVE] [PII], thank you so much. I do have another patient if you're able to assist me quickly, please.
[AGENT][NEUTRAL] Sure, give me one moment.
[CUSTOMER][POSITIVE] No problem.
[AGENT][NEUTRAL] What is the policy number that you're calling to verify benefits for [PII]?
[CUSTOMER][NEUTRAL] Yes, it's gonna be 02450356, N as in November, L as in Liam, 8.
[AGENT][NEUTRAL] And what is this member's name and date of birth?
[CUSTOMER][NEUTRAL] And it's for the paint
[CUSTOMER][NEUTRAL] [PII] [PII].
[AGENT][NEUTRAL] And you're calling to verify outpatient benefits and office business as well for the same patient?
[CUSTOMER][NEUTRAL] As well.
[CUSTOMER][NEUTRAL] For a specialist, correct.
[AGENT][NEUTRAL] Remember his
[AGENT][NEUTRAL] So the member's policy has outpatient benefits of $250 per calendar day, and this is not a guaranteed benefits, just a disclaimer of the policy's coverage. However, the office visit itself is not covered under the policy, but the treatment received in the office does fall under the outpatient benefits.
[CUSTOMER][POSITIVE] No problem.
[CUSTOMER][POSITIVE] OK perfect and the effective date I'm sorry?
[AGENT][NEUTRAL] Um, give me one moment.
[AGENT][NEUTRAL] This policy has been active since [PII] and it's currently active. Is there anything else that I can assist you with today?
[CUSTOMER][POSITIVE] There's nothing else. Thank you so much. You have a great rest of your Thursday, OK? Have a blessful weekend.
[AGENT][POSITIVE] Thanks for calling APL and you have a great one as well, [PII]. Goodbye. Thank you.
[CUSTOMER][NEUTRAL] Bye.