AccountId: 011433970860
ContactId: ef2ce631-8fd0-4eac-873f-4c84696c0ed5
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 195929 ms
Total Talk Time (AGENT): 113310 ms
Total Talk Time (CUSTOMER): 73650 ms
Interruptions: 0
Overall Sentiment: AGENT=1.3, CUSTOMER=0.2
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/02/25/ef2ce631-8fd0-4eac-873f-4c84696c0ed5_20250225T13:34_UTC.wav
--------------------------------------------
[AGENT][POSITIVE] Good Morning thank you for calling APL. My name is [PII]. How may I help you?
[CUSTOMER][NEUTRAL] Hey, hi, this is [PII] calling from provider's office. I just need to check the patient's eligibility and benefits. Can you please help me out for that?
[AGENT][POSITIVE] It would be my pleasure to assist you with eligibility and benefits, [PII]. What is the callback number, please?
[CUSTOMER][NEUTRAL] It is [PII]. It's a direct line.
[AGENT][NEUTRAL] Thank you, [PII]. And what is the policy number for the patient?
[CUSTOMER][NEUTRAL] Yeah, the policy number is 02123559.
[AGENT][NEUTRAL] Thank you and the patient's name and date of birth please, ma'am.
[CUSTOMER][NEUTRAL] Patient name is [PII] and the date of birth is [PII].
[AGENT][POSITIVE] Alright, thank you, and it would be my pleasure to assist you with the eligibility and benefits and I I'm showing that [PII]'s policy is active effective date is [PII].
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] And this is a secondary policy to the policyholders' major medical.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] And are you needing specific benefits?
[CUSTOMER][NEUTRAL] OK
[CUSTOMER][NEUTRAL] Um, no, just for specialist office instead.
[AGENT][NEUTRAL] OK, so for the office visit co-pay, she does not have benefits.
[AGENT][NEUTRAL] Um, for the office visit co-pay. Now she does have benefits for any treatments or procedures in office for sickness and injury diagnosis, but not for the office visit co-pay.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] OK. So, um, so will it cover the uh primary insurance, uh, co-insurance?
[AGENT][NEUTRAL] For procedures and treatments, the coinsurance and deductible.
[CUSTOMER][NEUTRAL] OK, fine. And um what about the diagnostic lab, uh will it be covered 100 persons?
[AGENT][NEUTRAL] Um, so her, um, procedure and treatment benefit is covered under her outpatient benefit. That benefit amount is $6650 per calendar year.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] Now there is a $500 deductible that has to be met prior to benefits being paid, and at this time [PII] has not met any of her deductible nor used any of her benefits.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] OK fine.
[CUSTOMER][NEUTRAL] OK, so yeah, that's it from my side, and can I get your name? Could you please spell it out?
[AGENT][NEUTRAL] My name is [PII]
[AGENT][NEUTRAL] First initial last name [PII].
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Mhm and can I get the call reference number?
[AGENT][NEUTRAL] And
[AGENT][NEUTRAL] Code reference number is my name and today's date.
[AGENT][NEUTRAL] And if you would please note also, [PII], that all benefits given over the phone is a verification of coverage and not a guarantee of payment.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][POSITIVE] Thank you so much for your assistance, [PII], and you have a wonderful day.
[AGENT][POSITIVE] It's been my pleasure. [PII], thank you for calling APL. It's a pleasure to assist you with that eligibility and benefit. I hope you have a wonderful day as well. Take care.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Bye bye.
[AGENT][NEUTRAL] Bye-bye.