AccountId: 011433970860
ContactId: f96d8735-2433-4057-8c8e-43643feee4bd
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 709919 ms
Total Talk Time (AGENT): 107885 ms
Total Talk Time (CUSTOMER): 111700 ms
Interruptions: 0
Overall Sentiment: AGENT=1.1, CUSTOMER=-0.6
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/04/15/f96d8735-2433-4057-8c8e-43643feee4bd_20250415T17:08_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]. My name is [PII] and I'm calling from Citrus Valley Gastroenterology. Well, I'd like to um
[CUSTOMER][NEUTRAL] Verify eligibility and um benefits for uh specialist office visit, please.
[AGENT][POSITIVE] Of course, [PII], I can help you with eligibility today.
[AGENT][NEUTRAL] Do you have the policy number on you?
[CUSTOMER][NEUTRAL] Policy number, um, let me check on that.
[CUSTOMER][NEUTRAL] It's 02576313.
[AGENT][POSITIVE] OK, thank you.
[AGENT][NEUTRAL] And then what's a good call back number in case our call gets dropped?
[CUSTOMER][NEUTRAL] All right. Um, it's area code [PII].
[AGENT][POSITIVE] OK, perfect.
[AGENT][NEUTRAL] OK, and then patient's first and last name and date of birth?
[CUSTOMER][NEUTRAL] Patient's name is [PII]. The date of birth is [PII].
[AGENT][POSITIVE] OK, thank you.
[CUSTOMER][NEUTRAL] Yeah.
[AGENT][NEUTRAL] OK, and it looks like the policy is active.
[AGENT][NEUTRAL] And the effective date is [PII].
[CUSTOMER][POSITIVE] All right. Thank you so much for that. Um, how about for the benefits for, um, specialist office visit?
[AGENT][NEUTRAL] Mhm.
[AGENT][NEUTRAL] Let's see.
[CUSTOMER][NEUTRAL] Is there any copay for the visit?
[AGENT][NEUTRAL] Let me see, just a moment.
[AGENT][NEUTRAL] OK, sorry, just a second while I pull up their policy certificate.
[CUSTOMER][NEUTRAL] Uh, sure.
[AGENT][NEUTRAL] OK. OK, do you mind if I put you on a brief hold so I can look further into this really quick?
[CUSTOMER][NEUTRAL] Yeah,
[AGENT][POSITIVE] OK, thank you.
[CUSTOMER][NEGATIVE] You are on hold.
[CUSTOMER][NEGATIVE] You are on hold.
[CUSTOMER][NEGATIVE] You are on hold.
[CUSTOMER][NEGATIVE] You are on hold.
[AGENT][POSITIVE] Hey [PII], thank you for holding.
[CUSTOMER][NEUTRAL] And
[AGENT][NEUTRAL] So, it looks like the insured, the patient has an outpatient sickness writer, and that covers office visits, and that's a maximum benefit per visit, $75. Maximum visit per calendar year is up to $5 per adult.
[CUSTOMER][NEUTRAL] Oh, OK.
[AGENT][NEUTRAL] OK, and this is not a guarantee of payment, just a verification of coverage.
[CUSTOMER][NEUTRAL] All right. Um, this 75, um,
[CUSTOMER][NEUTRAL] Is this a co-pay?
[AGENT][NEGATIVE] No, it is not.
[CUSTOMER][NEUTRAL] Um, I'm quite confused with that. Can you um can you clarify this one for me, please? Thank you so much for A.
[AGENT][NEUTRAL] OK, yes.
[AGENT][NEUTRAL] Mm
[AGENT][NEUTRAL] OK, so this is not a co-pay, this is just the maximum office visit benefit under this policy.
[CUSTOMER][NEUTRAL] All right.
[CUSTOMER][NEUTRAL] And so there's no copay for the visit?
[AGENT][NEUTRAL] It looks like co-pays are not covered under this policy.
[CUSTOMER][NEUTRAL] Mm
[CUSTOMER][NEUTRAL] All right. Um,
[CUSTOMER][NEUTRAL] I guess this would be all for now. Um, can I ask for the call reference number from you, [PII], and the initial of your last name? Thank you.
[AGENT][NEUTRAL] Yes, it is [PII], my first name.
[AGENT][NEUTRAL] [PII]
[CUSTOMER][NEUTRAL] Yes.
[AGENT][NEUTRAL] And my last initial, which is [PII]
[AGENT][NEUTRAL] And then today's date would be [PII].
[CUSTOMER][NEUTRAL] All right. Um, the, your first name and the initial of your last name then the today's date for the call reference number?
[AGENT][NEUTRAL] Yes, ma'am.
[CUSTOMER][NEUTRAL] Alright.
[CUSTOMER][POSITIVE] Thank you so much, [PII], for your time and for the help.
[AGENT][NEUTRAL] Of course, anytime.
[CUSTOMER][POSITIVE] Uh, I do appreciate that.
[AGENT][NEUTRAL] Yeah, is there anything else I can help you with?
[CUSTOMER][NEUTRAL] Alright, and this is
[CUSTOMER][NEUTRAL] No, this would be all for now.
[AGENT][POSITIVE] OK. Well, thank you for calling APL. I appreciate it, [PII].
[CUSTOMER][POSITIVE] Uh yeah, thank you.
[AGENT][NEUTRAL] Yeah.
[AGENT][POSITIVE] Yeah, have a good day. Bye.
[CUSTOMER][NEUTRAL] Bye bye.