AccountId: 011433970860
ContactId: fe4036e3-bfab-4d68-800b-27129aae6506
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 396739 ms
Total Talk Time (AGENT): 156324 ms
Total Talk Time (CUSTOMER): 177590 ms
Interruptions: 1
Overall Sentiment: AGENT=1.6, CUSTOMER=1
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/01/31/fe4036e3-bfab-4d68-800b-27129aae6506_20250131T17:08_UTC.wav
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[AGENT][NEUTRAL] Hi, thank you for calling APL. This is [PII]. How can I help you today?
[CUSTOMER][NEUTRAL] Hi, good you said your name is [PII]? OK, perfect. Sorry, it just sounded you sounded really far away at the beginning. Hi [PII], my name is [PII]. I'm calling from Cypress Creek Outpatient Surgical Center. I'm just calling to see if I can get eligibility and a um and benefits on a patient who's having a procedure done.
[AGENT][POSITIVE] Yes, correct.
[AGENT][NEUTRAL] Mhm.
[AGENT][NEUTRAL] OK, yeah, I'd love to help you with eligibility and but if it's today, Miss [PII], do you mind if I snag that call back number real quick?
[CUSTOMER][NEUTRAL] Sure it's [PII].
[AGENT][NEUTRAL] Perfect. And what is the policy number we want to look at today, Ms. [PII]?
[CUSTOMER][NEUTRAL] Um, she gave me 01416189.
[AGENT][NEUTRAL] Mhm.
[AGENT][NEUTRAL] Mhm.
[AGENT][POSITIVE] Perfect.
[CUSTOMER][NEUTRAL] You don't need it.
[AGENT][NEUTRAL] And
[AGENT][POSITIVE] get that all pulled up for you.
[CUSTOMER][NEUTRAL] Well
[CUSTOMER][NEUTRAL] I
[CUSTOMER][NEUTRAL] Start [PII] here at [PII].
[AGENT][NEUTRAL] Thank you. And would you be able to verify for me, please, uh, your insured's first and last name and date of birth?
[CUSTOMER][NEUTRAL] [PII] [PII].
[AGENT][POSITIVE] Perfect, thank you and.
[CUSTOMER][NEUTRAL] So
[AGENT][NEUTRAL] I do see she is current and active. It looks like she's been effective since [PII], and then for benefits we're looking outpatient today.
[CUSTOMER][NEUTRAL] Uh
[CUSTOMER][NEUTRAL] around it.
[CUSTOMER][POSITIVE] Correct.
[AGENT][POSITIVE] Perfect, let me get that loaded for you.
[CUSTOMER][POSITIVE] Yeah, I love that for you.
[CUSTOMER][NEUTRAL] Yeah
[AGENT][NEUTRAL] Alright, and while that's pulling up, I do wanna let you know that any benefits I give you over the phone will just be a verification of coverage and not a guarantee of payment.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] And I do see that she has.
[AGENT][NEUTRAL] An outpatient, what's this, let me look at that.
[AGENT][NEUTRAL] Sorry, let me pull up her policy documents. That snapshots just not loading correctly. Give me one second, OK?
[CUSTOMER][POSITIVE] No, you're fine. Take your time.
[AGENT][NEUTRAL] Doing anything exciting for the weekend?
[CUSTOMER][NEUTRAL] Oh no, just the weekend itself, honestly, just waiting for the weekend.
[AGENT][POSITIVE] That's nice
[AGENT][POSITIVE] It's so close, you're almost there.
[CUSTOMER][NEUTRAL] I
[CUSTOMER][NEUTRAL] I know, patiently waiting.
[AGENT][NEUTRAL] Do you have to work really late? Oh, I'm
[CUSTOMER][NEUTRAL] What about you? Any?
[CUSTOMER][NEGATIVE] Oh no.
[CUSTOMER][POSITIVE] Thank God for that.
[AGENT][POSITIVE] I have no plans. I'm just the same. I'm ready for it when it happens.
[CUSTOMER][NEUTRAL] Right.
[AGENT][NEUTRAL] Um,
[AGENT][NEUTRAL] All right, so I am seeing here.
[AGENT][NEUTRAL] Um, I know we said outpatient. Is her procedure being done in
[CUSTOMER][NEUTRAL] At an ambulatory surgical center.
[AGENT][NEUTRAL] A
[AGENT][NEUTRAL] Oh perfect. OK, thank you. So that would fall under her just general outpatient benefits and it looks like we have about $500 I I would say about we have $500 per person per calendar year.
[CUSTOMER][NEUTRAL] OK, so you cover up, uh, is it OK, so you guys cover $500 per calendar year.
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Has she used that so far?
[AGENT][POSITIVE] That is an excellent question. Um, I'm not showing any anything for the [PII] calendar year.
[CUSTOMER][NEUTRAL] Or use any?
[CUSTOMER][NEUTRAL] OK, so you guys only cover up to $500 for whatever the primary is.
[AGENT][NEUTRAL] Uh, 500, yeah, for, uh, what's applied to their co-pay, co-insurance and deductible after major medical pays.
[CUSTOMER][POSITIVE] OK, good.
[CUSTOMER][NEUTRAL] I said I start at [PII].
[CUSTOMER][NEUTRAL] OK, I think it's pretty late before I say that, um.
[CUSTOMER][NEUTRAL] Oh, maybe she thought she was gonna be covered more.
[CUSTOMER][NEUTRAL] OK, let's see, so it's just $500 that you guys cover now, uh, to send claims, what PO box would we be sending claims to?
[AGENT][NEUTRAL] Yeah, you're gonna wanna send claims to [PII] and then that's in.
[CUSTOMER][NEUTRAL] 24895.
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] 0
[AGENT][POSITIVE] Perfect. That's out of [PII].
[AGENT][NEUTRAL] And our zip code is [PII].
[CUSTOMER][NEUTRAL] What was the zip code again?
[AGENT][NEUTRAL] [PII].
[CUSTOMER][NEUTRAL] OK, does this um plan like have a group number or group ID or anything like that or no?
[AGENT][NEUTRAL] Yeah, so we have a group number for that. It should be 16048.
[CUSTOMER][NEUTRAL] 16048
[AGENT][NEUTRAL] Mhm. And then the group name is Flexol Packing Court.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK, alright, so I'm just gonna kinda go over it so far. effective date is [PII]. Uh, group number is 16048 supplemental plan, uh, this policy for outpatient covers $500 per calendar year, none used so far, sending claims to [PII].
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][POSITIVE] OK, perfect.
[CUSTOMER][NEUTRAL] Now [PII], can I get a reference number for this call, please?
[AGENT][NEUTRAL] Oh, you betcha. It's just gonna be my name, [PII], first initial, last name, [PII], in today's date.
[CUSTOMER][POSITIVE] Perfect. Well thank you so much, [PII]. You've been such a great help.
[AGENT][POSITIVE] Well, it's my pleasure. Thank you for calling APL and I hope you have a fabulous weekend. get some good rest.
[CUSTOMER][POSITIVE] You as well. Thank you so much. You too. Bye-bye.
[AGENT][POSITIVE] Thank you. My pleasure. Bye-bye.