AccountId: 011433970860
ContactId: f5b8f2aa-2459-4b46-b3bf-e0c1de87b45c
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 449130 ms
Total Talk Time (AGENT): 159753 ms
Total Talk Time (CUSTOMER): 140585 ms
Interruptions: 1
Overall Sentiment: AGENT=0.8, CUSTOMER=1.5
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/05/07/f5b8f2aa-2459-4b46-b3bf-e0c1de87b45c_20250507T20:00_UTC.wav
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[AGENT][NEUTRAL] Thank you for calling APL. This is [PII]. How may I help you?
[CUSTOMER][NEUTRAL] Hi [PII]. Good afternoon. My name is [PII]. Miss [PII], I'm calling from the University of Texas MD Anderson Cancer Center. I'm calling for benefits and eligibility information on the patient, please.
[AGENT][NEUTRAL] OK, Miss [PII], I can help you with benefits and eligibility. Uh, what is your callback number, ma'am? Just in case the call is dropped.
[CUSTOMER][NEUTRAL] My direct line is [PII].
[AGENT][NEUTRAL] Thank you, ma'am. And then what is the patient's name, date of birth, and policy number?
[CUSTOMER][NEUTRAL] [PII].
[CUSTOMER][NEUTRAL] [PII].
[CUSTOMER][NEUTRAL] Policy 726-688.
[AGENT][NEUTRAL] OK, let me look that up real quick.
[CUSTOMER][POSITIVE] OK, thank you.
[AGENT][POSITIVE] You're very welcome.
[AGENT][NEUTRAL] OK, this is a cancer policy. The effective date of the policy is [PII]. The policy is active.
[AGENT][NEUTRAL] And she has, let's see, let me pull up her benefits real quick.
[AGENT][NEUTRAL] See.
[AGENT][NEUTRAL] Are you looking for inpatient benefits?
[CUSTOMER][NEUTRAL] Uh, for a specialist office visit and outpatient benefits for a CT scan.
[AGENT][NEUTRAL] OK. Has she already been diagnosed with cancer?
[CUSTOMER][NEUTRAL] Um, let me see, one second.
[CUSTOMER][NEUTRAL] Let me check, let me check.
[CUSTOMER][NEUTRAL] So I don't believe so because um it's a new patient visit.
[AGENT][NEUTRAL] OK. And is it a wellness visit?
[CUSTOMER][NEUTRAL] Um,
[CUSTOMER][NEUTRAL] Let me see.
[AGENT][NEUTRAL] Yes, ma'am. I'm sorry, I'm answering so many questions, but on this policy, this is a cancer policy and it only goes into effect if the patient has initially been diagnosed with cancer.
[CUSTOMER][NEUTRAL] Oh, OK.
[CUSTOMER][NEUTRAL] I, mm.
[CUSTOMER][NEUTRAL] Yes, patient.
[CUSTOMER][NEUTRAL] OK, yeah, because I'm really not sure, um.
[CUSTOMER][NEUTRAL] Let me see, I can just take note of that here.
[AGENT][NEUTRAL] Yes ma'am.
[CUSTOMER][NEUTRAL] Um, I don't, mm.
[AGENT][NEUTRAL] I'm gonna look and see if she has.
[CUSTOMER][POSITIVE] But thank you for, you know, the.
[AGENT][NEUTRAL] You're welcome and I'm gonna look and see if she does have benefits for wellness, um, because some of our policies have that wellness benefit on there that they can use to get screenings and things like that for um.
[AGENT][NEUTRAL] Oh, what am I preventative, is what I'm trying to say.
[CUSTOMER][POSITIVE] OK, yes, that'll be perfect.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] OK, so on this policy.
[CUSTOMER][NEUTRAL] Can we check for a um mammogram?
[AGENT][NEUTRAL] Yes, um, and this is just to verify benefits. It's not a guarantee of payment. She does have a benefit for diagnostic and prevention benefit for a mammogram on this policy.
[AGENT][NEUTRAL] And let me see what that pays for you.
[CUSTOMER][POSITIVE] OK, great.
[AGENT][NEUTRAL] Let me check her benefit breakdown our schedule of benefits and see how much it pays.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] OK, so her diagnostic and pre prevention benefit pays $60 per calendar year.
[CUSTOMER][NEUTRAL] OK. Is there like um a max um number of visits or anything like that or max max amount?
[AGENT][NEUTRAL] No, ma'am. It's just one diagnostic and prevention benefit per calendar year, one time a year of $60.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Is there like a co-pay or something like that?
[AGENT][NEUTRAL] No, it's just a set amount.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] And that's just um once per year, once per calendar year.
[AGENT][NEUTRAL] Yes, ma'am.
[AGENT][NEUTRAL] Yes, ma'am.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][POSITIVE] Thank you so much, Ms. [PII] for that information. Is there a reference number? Oh, actually, um, is there a payer ID for electronic claims, please?
[AGENT][NEUTRAL] Yes, ma'am. Our payer ID number is 60801.
[CUSTOMER][NEUTRAL] OK, that's 68 I mean [PII].
[AGENT][POSITIVE] Yes, that's correct.
[CUSTOMER][POSITIVE] Perfect. And then what about the claims mailing address?
[AGENT][NEUTRAL] The claim's mailing address is [PII].
[AGENT][NEUTRAL] And that's in [PII].
[AGENT][NEUTRAL] And then the zip code is [PII].
[CUSTOMER][NEUTRAL] OK, let me repeat that back.
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] That's [PII].
[CUSTOMER][NEUTRAL] [PII]
[AGENT][POSITIVE] Yes, you've got it.
[CUSTOMER][POSITIVE] OK. Perfect.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] Ms. [PII], can I help?
[CUSTOMER][POSITIVE] Thank you so much, Ms. [PII] for that information.
[AGENT][NEUTRAL] Oh, well, you're welcome. Is there anything?
[CUSTOMER][NEUTRAL] No, may I have a reference number, please?
[AGENT][NEUTRAL] Sure, you can use my name and today's date.
[CUSTOMER][POSITIVE] Awesome. Thank you so much, Ms. [PII]. Take care. You have a great rest of the day.
[AGENT][POSITIVE] You too, Ms. [PII], and have a good weekend.
[AGENT][POSITIVE] Bye bye. Thanks for calling ATL. You're welcome.
[CUSTOMER][POSITIVE] Thank you. Likewise. Bye-bye.