AccountId: 011433970860
ContactId: ebd6ef8b-20d0-4749-b6f0-0266b0318d71
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 486380 ms
Total Talk Time (AGENT): 119246 ms
Total Talk Time (CUSTOMER): 143517 ms
Interruptions: 1
Overall Sentiment: AGENT=0.9, CUSTOMER=0.8
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/02/19/ebd6ef8b-20d0-4749-b6f0-0266b0318d71_20250219T17:26_UTC.wav
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[AGENT][NEUTRAL] Thank you for calling APL. This is. How may I help you?
[CUSTOMER][NEUTRAL] Hi, uh, I'm calling for a provider's office to, um, get benefits on a member please.
[AGENT][NEUTRAL] OK, I can help you with benefits. Can you please give me your name, your callback number, and the provider's office you're calling from?
[CUSTOMER][NEGATIVE] I'm sorry, you're breaking up um I couldn't understand what you said.
[AGENT][NEUTRAL] Yes, I can help you with benefits. Can you please give me your name, your callback number, and the provider's office you're calling from?
[CUSTOMER][NEUTRAL] Yes, my name is [PII].
[CUSTOMER][NEUTRAL] I'm calling from Digestive Medicine Associates and my callback number is [PII].
[AGENT][NEUTRAL] OK, thank you so much Ms. [PII], and then what is the name of the patient, the date of birth, and policy number?
[CUSTOMER][NEUTRAL] Yes, um, patient's name is [PII].
[CUSTOMER][NEUTRAL] Date of birth is [PII].
[CUSTOMER][NEUTRAL] And the policy number is 023.
[CUSTOMER][NEUTRAL] 1987.
[CUSTOMER][NEUTRAL] 1
[CUSTOMER][NEUTRAL] M as in Mary, L as in Laura, number 8.
[AGENT][POSITIVE] OK thank you let me look up that policy real quick for us.
[CUSTOMER][POSITIVE] Thank you.
[AGENT][NEUTRAL] OK, I do show that [PII] does have an active policy and his effective date is [PII].
[AGENT][NEUTRAL] And this is just to verify coverage it's not a guarantee of payment. This is supplemental insurance policy that's billed secondary to the primary. It's a gap insurance that helps with deductible, co-pay and co-insurance.
[AGENT][NEUTRAL] The insured has an outpatient benefit amount per calendar year of $1000.
[CUSTOMER][NEUTRAL] 1000.
[AGENT][NEUTRAL] Yes.
[AGENT][NEUTRAL] He also has an inpatient benefit amount per calendar year of [PII].
[CUSTOMER][NEUTRAL] Has anything been used?
[AGENT][NEUTRAL] Let me check for you.
[CUSTOMER][NEUTRAL] OK, for the outpatient, yes, for the outpatient, can you check the accumulation, please?
[AGENT][NEUTRAL] Yes.
[AGENT][NEGATIVE] Nothing has been used for the year of [PII].
[CUSTOMER][NEUTRAL] OK, and would that cover, um, surgeries done in, in an office, in an office setting?
[AGENT][NEUTRAL] Let me
[AGENT][NEUTRAL] Let me look and see.
[CUSTOMER][POSITIVE] Thank you.
[AGENT][POSITIVE] You're welcome.
[AGENT][NEUTRAL] I'm going to pull in the
[CUSTOMER][NEUTRAL] Hello?
[AGENT][NEUTRAL] He has benefits for accident or sickness. Yes, I'm going to pull in the policy and read it and look and see if there's any surgery benefits for this insured.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] It's gonna be just a second while the computer loads it.
[CUSTOMER][NEUTRAL] OK
[CUSTOMER][NEUTRAL] Yeah
[CUSTOMER][NEUTRAL] OK
[CUSTOMER][NEUTRAL] Give me just a second
[CUSTOMER][NEUTRAL] you
[AGENT][NEUTRAL] It's taking a little bit, but it'll get there.
[AGENT][NEUTRAL] OK, let's look and see.
[CUSTOMER][NEUTRAL] It didn't uh a United share services uh being benefits but um.
[CUSTOMER][NEUTRAL] Pa.
[CUSTOMER][NEUTRAL] No, no, mm.
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] Yeah.
[AGENT][NEUTRAL] Yes, the, um, insured can go to a free-standing outpatient surgery center.
[CUSTOMER][NEUTRAL] OK, but I asked office.
[AGENT][NEUTRAL] OK, let me look and see, let me look and see if office is covered.
[CUSTOMER][NEUTRAL] In an office.
[CUSTOMER][POSITIVE] Mhm thank you.
[CUSTOMER][NEUTRAL] It'll be better but no it no.
[AGENT][NEUTRAL] No, ma'am, it's not for an office. It is a free standing.
[CUSTOMER][NEUTRAL] So he would only be covered if he goes to a free standing facility.
[AGENT][POSITIVE] Correct.
[CUSTOMER][NEUTRAL] OK, not in the office.
[AGENT][POSITIVE] Correct.
[CUSTOMER][POSITIVE] OK perfect let me just make sure I tell the patient um OK perfect uh thank you so much for your help. Can I please have your name?
[AGENT][NEUTRAL] Yes, my name is [PII].
[CUSTOMER][NEUTRAL] Sorry.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][POSITIVE] OK [PII], thank you so much for your help. I'll go ahead and advise the number. Thank you.
[AGENT][POSITIVE] You're very welcome, Miss [PII]. You have a great day and thanks for calling APL.
[CUSTOMER][POSITIVE] Thank you you too bye bye.