AccountId: 011433970860
ContactId: f9a2b981-5405-4491-b9ec-52ca96b99d5a
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 162100 ms
Total Talk Time (AGENT): 82711 ms
Total Talk Time (CUSTOMER): 40667 ms
Interruptions: 0
Overall Sentiment: AGENT=1.1, CUSTOMER=1.6
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/02/28/f9a2b981-5405-4491-b9ec-52ca96b99d5a_20250228T19:04_UTC.wav
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[AGENT][NEUTRAL] Thank you for calling APL. This is [PII]. How can I help you?
[CUSTOMER][POSITIVE] Um, hi, good afternoon, [PII]. I would like to get an eligibility benefits for a patient.
[AGENT][NEUTRAL] Sure, I can take eligibility and benefits for you. Uh, what was your name?
[CUSTOMER][NEUTRAL] [PII]
[AGENT][NEUTRAL] OK, [PII], can I get a good call back number from you in case we're disconnected?
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] Thank you. And then do you have the policy number?
[CUSTOMER][NEUTRAL] 02509831
[AGENT][NEUTRAL] OK. And what was the name and date of birth for the insured?
[CUSTOMER][NEUTRAL] [PII] [PII].
[AGENT][NEUTRAL] Perfect, thank you for verifying that. Uh, so this policy is active. Effective date was January or excuse me, [PII], and this is a secondary medical policy, so it is designed to help with co-pay, deductible and co-insurance after major medical pays, and we're we need to look at the outpatient benefits?
[CUSTOMER][NEUTRAL] Yes, specialist visit.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] OK, and of course I will let you know verification of coverage. I'm sorry?
[CUSTOMER][NEUTRAL] What's your initial
[CUSTOMER][NEUTRAL] [PII], can I have your initial?
[AGENT][NEUTRAL] Yeah, my last initial is A.
[CUSTOMER][POSITIVE] Thank you, go on.
[AGENT][NEUTRAL] Of course, yes, I will let you know verification of coverage is not a guarantee of payment for claims. The outpatient benefit is $8700 max per calendar year and if you'll give me one moment, I'll see if any of that has been used.
[AGENT][NEUTRAL] OK, none has been used so far this year.
[CUSTOMER][NEUTRAL] Is office visit covered under the plan?
[AGENT][NEUTRAL] Let me check that.
[AGENT][NEUTRAL] You did say this was a specialist office.
[CUSTOMER][NEUTRAL] Yes.
[AGENT][NEUTRAL] OK, so office visits under this policy are not covered, however, treatment received in office could be.
[CUSTOMER][NEUTRAL] Again, the outpatient benefit maximum is 8700.
[AGENT][POSITIVE] Correct.
[CUSTOMER][NEUTRAL] Uh, what's the reference number for this call?
[AGENT][NEUTRAL] It would be my first name, last initial, and today's date. Uh, so my first name is spelled [PII] And was there anything else I could help you with?
[CUSTOMER][POSITIVE] That will be all. Thank you so much.
[AGENT][POSITIVE] Of course, thanks for calling API. I hope you have a great rest of your day.
[CUSTOMER][POSITIVE] Thank you. Bye.
[AGENT][POSITIVE] Thank you bye bye.