AccountId: 011433970860
ContactId: f4fc1a2b-8dcc-470a-9314-f17c0bd03f2a
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 440609 ms
Total Talk Time (AGENT): 112243 ms
Total Talk Time (CUSTOMER): 173340 ms
Interruptions: 1
Overall Sentiment: AGENT=0.9, CUSTOMER=0.6
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/06/04/f4fc1a2b-8dcc-470a-9314-f17c0bd03f2a_20250604T19:59_UTC.wav
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[AGENT][NEUTRAL] Good afternoon. Thank you for calling APL. This is [PII]. May I help you?
[CUSTOMER][NEUTRAL] Good afternoon, [PII]. My name is [PII]. I'm calling to verify benefits uh for a patient.
[AGENT][NEUTRAL] OK. How do you spell your name?
[CUSTOMER][NEUTRAL] It's [PII]
[AGENT][NEUTRAL] And do you have a phone number with that I can get in case we get disconnected I can call you back?
[CUSTOMER][NEUTRAL] Of course. It is [PII], and it is a direct line.
[AGENT][NEUTRAL] Thank you, [PII]. And do you have a policy number?
[CUSTOMER][NEUTRAL] Yes, it's 02249238.
[AGENT][NEUTRAL] Thank you, hold on one moment please.
[CUSTOMER][NEUTRAL] Mhm. Of course.
[AGENT][NEUTRAL] And what's the patient's name?
[CUSTOMER][NEUTRAL] Is [PII] and the date of birth is [PII].
[AGENT][NEUTRAL] Thank you, [PII], and you were just needing benefits?
[CUSTOMER][NEUTRAL] Yes, I would like to know something about this, this patient. I would like to know if you guys cover my outpatient diagnostic services.
[AGENT][NEUTRAL] OK, I can help you with that. The effective date is [PII].
[AGENT][NEUTRAL] Any benefits given over the phone is not a guarantee of payment. This policy coordinates with the primary insurance.
[AGENT][NEUTRAL] Whatever the primary applies to the deductible, co-pay, or co-insurance for outpatient, we'll pay up to $500 per occurrence.
[CUSTOMER][NEUTRAL] Oh
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Give me one second, so you cover up to 500, 500.
[AGENT][NEUTRAL] So right, per occurrence.
[CUSTOMER][NEUTRAL] Oh
[CUSTOMER][NEUTRAL] OK. And the patient has met anything about uh
[AGENT][NEUTRAL] You have the diagnosis code?
[CUSTOMER][NEUTRAL] Oh yes, I have one,
[CUSTOMER][NEUTRAL] Just 1 2nd, [PII].
[CUSTOMER][NEUTRAL] Um, I have here N as in November 40.1.
[AGENT][NEUTRAL] 40.1. OK, hold on one moment, let me check, OK?
[CUSTOMER][POSITIVE] OK, thank you.
[AGENT][NEUTRAL] No, ma'am. I'm not showing that they've used anything.
[CUSTOMER][NEUTRAL] I said.
[CUSTOMER][NEUTRAL] OK. Um, give me one second.
[CUSTOMER][NEUTRAL] So that you, uh, outpatient diagnostic services are covered up to $500 even nothing has been met. Um, we would like to know, you pick up um all the insurance, the deductible, and the copays for the primary.
[AGENT][NEUTRAL] Right, deductible, co-pay, or co-insurance?
[CUSTOMER][NEUTRAL] OK. The office visit, [PII], will be, uh, will be covered.
[AGENT][NEUTRAL] The
[AGENT][NEUTRAL] The office visit, we pay.
[AGENT][NEUTRAL] Is it, um, $25 per office visit?
[AGENT][NEUTRAL] Hold on one moment, please.
[CUSTOMER][NEUTRAL] OK. OK. OK.
[CUSTOMER][NEUTRAL] But.
[CUSTOMER][NEUTRAL] that's for Sunday.
[CUSTOMER][NEUTRAL] So the last week.
[AGENT][NEUTRAL] Yes, we paid $25 per offices 4 times per calendar year.
[CUSTOMER][NEUTRAL] OK, so you cover, OK.
[CUSTOMER][NEUTRAL] So office visits are covered up to up to $25.
[AGENT][NEUTRAL] Right.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Oh, let me check. OK.
[CUSTOMER][NEUTRAL] OK. So, OK, [PII], let's um recap. The second day of the patient is [PII]. Um, you cover um up to 500, nothing has been met. You pick up all the car insurance, deductible and the co-pays, and office visits are covered up to $25.
[AGENT][NEUTRAL] Right, 4 times per calendar year.
[CUSTOMER][POSITIVE] OK, thank
[CUSTOMER][NEUTRAL] OK, 4 times.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] 4 times per calendar year. OK.
[CUSTOMER][POSITIVE] Thank you so much, [PII]. May I have the call reference number?
[AGENT][NEUTRAL] And he has, yes, ma'am. He has used one.
[AGENT][NEUTRAL] 2
[AGENT][NEUTRAL] 3 office visits. Hold on just a moment.
[AGENT][NEUTRAL] Let me check for you.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] Yeah, 3 office visits already, so he only has 1 left for this year.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] And we do not have reference numbers. You can use my name in today's date.
[CUSTOMER][NEUTRAL] Let me put this
[CUSTOMER][NEUTRAL] Let's see.
[CUSTOMER][NEUTRAL] Give me 1 2nd.
[CUSTOMER][NEUTRAL] OK
[CUSTOMER][NEUTRAL] Patient has used 3 of his visits already and just have 1 left for this calendar year.
[AGENT][POSITIVE] Correct. Uh-huh.
[CUSTOMER][POSITIVE] OK, OK, thank you, [PII].
[AGENT][POSITIVE] Thank you, [PII], for calling APL. You have a good afternoon.
[CUSTOMER][POSITIVE] You too, you too. Thank you so much.
[AGENT][POSITIVE] Thank you. Mhm. Bye-bye.
[CUSTOMER][NEUTRAL] Mhm bye-bye.