AccountId: 011433970860
ContactId: fa05982b-c430-40d9-a00b-5bc4a47de7de
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 394660 ms
Total Talk Time (AGENT): 138463 ms
Total Talk Time (CUSTOMER): 90593 ms
Interruptions: 0
Overall Sentiment: AGENT=0.9, CUSTOMER=0.2
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/03/27/fa05982b-c430-40d9-a00b-5bc4a47de7de_20250327T17:49_UTC.wav
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[AGENT][POSITIVE] Good afternoon. Thank you for calling APL. My name is [PII]. How may I help you?
[CUSTOMER][NEUTRAL] Hi, um, good afternoon, [PII]. I was calling to get eligibility and benefits for 2 patients.
[AGENT][POSITIVE] OK, well, I can definitely help you with the eligibility and benefits. And may I have your name and a good contact number in case we're disconnected?
[CUSTOMER][NEUTRAL] Yes, my name is [PII]. It's [PII] Callback number is [PII].
[AGENT][NEUTRAL] Thank you for that. And may I have the member's policy number?
[CUSTOMER][NEUTRAL] Um, the first one is 02120639 M as in Mike, L as in Lima, 8.
[AGENT][NEUTRAL] Thank you and can you verify the member's first and last name and date of birth?
[CUSTOMER][NEUTRAL] Um, patient's name is [PII]. Date of birth is [PII].
[AGENT][NEUTRAL] Thank you for that and all the information provided is a verification of benefits, not a guarantee of payment. So I am showing the policy is active. It's been effective since [PII]. And what type of benefits did you want to go over today?
[CUSTOMER][NEUTRAL] It's gonna be for a specialist office visit and then for allergy services for skin testing, injection and serum.
[AGENT][NEUTRAL] OK, so for the
[AGENT][NEUTRAL] Out, well, in office, the policy itself doesn't provide any in-office treatment. It does have the office treatment rider. So any, any treatment done in the office as long as it's not cosmetic could be covered up to that $4000 per calendar year maximum.
[AGENT][NEUTRAL] Did you want me to see if any has been used?
[CUSTOMER][NEUTRAL] Um, yes, please.
[AGENT][NEUTRAL] OK, hold on one moment.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEGATIVE] And none of the Max has been used for 2025.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] And then that um Max would apply for the skin testing, the injections and serum.
[AGENT][NEUTRAL] Let me see if there's any um exclusions. Hold on one second.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] And do you mind if I place you on just a brief hold?
[CUSTOMER][POSITIVE] Um, no problem, thank you.
[AGENT][NEUTRAL] Alright, hold on one moment. You're welcome.
[CUSTOMER][NEGATIVE] You are on hold.
[CUSTOMER][NEGATIVE] You are on hold.
[AGENT][NEUTRAL] Hello, [PII].
[CUSTOMER][NEUTRAL] Yes.
[AGENT][NEUTRAL] Thank you so much for holding. I apologize for the wait. So yes, the policy exclusion doesn't um specify like exclude or specify any of the skin testing or injections or serums. Um, so the only way to definitely guarantee would be to process the claim, but if it's considered treatment in the office, she does have the office treatment writer or he does have the office treatment rider.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] OK perfect alrighty and then can I check um for the same benefits but for a different patient?
[AGENT][NEUTRAL] Sure, um, what's the next member's policy number?
[CUSTOMER][NEUTRAL] Yes, that is 02094968, M as in Mike, L as in Lima 8.
[AGENT][NEUTRAL] And can you verify the member's first and last name and date of birth?
[CUSTOMER][NEUTRAL] A member's name is [PII]. Date of birth is [PII].
[AGENT][NEUTRAL] Thank you for that and all the information provided is a verification of benefits, not a guarantee of payment. So I am showing that the policy is active, it's been effective since [PII] and let me see what type of
[AGENT][NEUTRAL] Hold on one moment.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] Um, it's the same type of thing as far as the office treatment provider versus um the facility charge, but the calendar year max for this policy is $5500.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] OK and has she made anything towards that one?
[AGENT][NEUTRAL] Um, let's see.
[AGENT][NEUTRAL] No, she has not used any of the benefits for [PII].
[CUSTOMER][NEUTRAL] OK, alrighty, and uh, and then, um, just to get the first initial to your last name and then just a reference number for the call today, that'll be it.
[AGENT][NEUTRAL] Alright, so there's no, there's no call reference number, but you can use my name in today's date. First initial and my last name is [PII].
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][POSITIVE] OK, alrighty thank you so much.
[AGENT][POSITIVE] You're very welcome and thanks for calling APL. I hope you have a great day.
[CUSTOMER][POSITIVE] You as well thank you bye bye.
[AGENT][POSITIVE] Thank you, bye bye.