AccountId: 011433970860
ContactId: fd826b23-9de1-477d-beaa-0b4ab1d0929a
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 151119 ms
Total Talk Time (AGENT): 63178 ms
Total Talk Time (CUSTOMER): 77905 ms
Interruptions: 1
Overall Sentiment: AGENT=1.3, CUSTOMER=0.3
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/03/20/fd826b23-9de1-477d-beaa-0b4ab1d0929a_20250320T14:10_UTC.wav
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[AGENT][POSITIVE] Thanks for calling APL. This is [PII]. How may I assist you?
[CUSTOMER][NEUTRAL] Hi, I'm calling for benefits for a patient that's coming in for an office visit and ultrasound in the specialist office.
[AGENT][POSITIVE] Sure, I can assist you with that. Can I have your name and a callback number?
[CUSTOMER][NEUTRAL] Yeah my name is [PII]. Call back is [PII].
[AGENT][NEUTRAL] [PII], what's the policy number of the member that you're requesting benefits for?
[CUSTOMER][NEUTRAL] It is, let's see here.
[CUSTOMER][NEUTRAL] Oh, it's a short number 60801?
[AGENT][NEUTRAL] It should say inpatient or outpatient er number?
[CUSTOMER][NEUTRAL] Yeah, I think they inputted it wrong. OK, it's um 024398.
[CUSTOMER][NEUTRAL] Yeah
[CUSTOMER][NEUTRAL] 94 ML 8.
[AGENT][NEUTRAL] Thank you. Could you verify that patient's name and date of birth that you're verifying eligibility for?
[CUSTOMER][NEUTRAL] Yes, it is [PII], um date of birth [PII].
[AGENT][NEUTRAL] Uh
[AGENT][NEUTRAL] And you're calling to verify benefits eligibility for outpatient services or office visits.
[CUSTOMER][NEUTRAL] It's um for a specialist office visit but also they're gonna do an ultrasound in the specialist office so I wanna see if there's any coverage on it.
[AGENT][NEUTRAL] So office visits are not covered, nor is the treatment received in the office. However, if she's getting a diagnostic testing done in a diagnostic facility, then it'll be covered under her outpatient benefits.
[CUSTOMER][NEUTRAL] Got it, but any diagnostic services done in the office specialist office doesn't isn't covered, right?
[AGENT][NEUTRAL] Yes, that is correct, and her policy has been active since [PII] and it's currently active.
[CUSTOMER][NEUTRAL] OK
[CUSTOMER][NEUTRAL] [PII]. OK, alright, cool. What are her outpatient um benefits? I might as well document it.
[AGENT][NEUTRAL] She has outpatient benefits of $5000 per calendar year, and this is not a guaranteed benefits, just a disclaimer of the policy's coverage.
[CUSTOMER][NEUTRAL] OK, anything used so far?
[AGENT][NEUTRAL] No.
[CUSTOMER][NEUTRAL] OK, and what about inpatient?
[AGENT][NEUTRAL] 5000 per calendar year as well.
[CUSTOMER][NEUTRAL] Same, OK.
[CUSTOMER][NEUTRAL] Got it. Alright, what was your name again? I'm sorry, no.
[AGENT][NEUTRAL] Is there anything else that I can assist you with today? [PII], today's date is the reference.
[CUSTOMER][POSITIVE] All right perfect thanks for your help.
[AGENT][POSITIVE] You're welcome. Thanks for calling APL and have a great day.
[CUSTOMER][NEUTRAL] OK