AccountId: 011433970860
ContactId: ff3912bb-4f5b-4d63-9ebd-824be6aed72d
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 173179 ms
Total Talk Time (AGENT): 51561 ms
Total Talk Time (CUSTOMER): 71570 ms
Interruptions: 0
Overall Sentiment: AGENT=1.9, CUSTOMER=0.3
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/05/09/ff3912bb-4f5b-4d63-9ebd-824be6aed72d_20250509T19:43_UTC.wav
--------------------------------------------
[AGENT][NEUTRAL] Thank you for calling APL. This is [PII]. How can I help you?
[CUSTOMER][NEUTRAL] Hi, I was calling to get eligibility on a patient and then on a member and then see if they've got a deductible for their plan.
[AGENT][POSITIVE] OK, I can help you with eligibility and benefits. Do you have a good callback number and can I get your name?
[CUSTOMER][NEUTRAL] My name is [PII] and a good callback number is [PII].
[AGENT][NEUTRAL] OK, thank you, [PII]. And do you have the policy number for that patient?
[CUSTOMER][NEUTRAL] Yes ma'am, that policy number is.
[CUSTOMER][NEUTRAL] 02435569
[AGENT][NEUTRAL] And patient name and date of birth?
[CUSTOMER][NEUTRAL] [PII] date of birth [PII].
[AGENT][POSITIVE] OK, thank you.
[AGENT][NEUTRAL] And is that for outpatient benefits?
[CUSTOMER][NEUTRAL] Yes ma'am.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] Um, anything I quote is not a guarantee of payment. It's the basic outline of the policy. Let me get that pulled up, one moment.
[CUSTOMER][NEUTRAL] Yes ma'am.
[AGENT][NEUTRAL] It looks like for her outpatient benefit, it pays a maximum of $3400 per calendar year, and there's no deductible.
[CUSTOMER][NEUTRAL] Alrighty, and then do you know what this would cover the copay for the patient's primary insurance or would they need to go ahead and pay that co-pay?
[AGENT][NEUTRAL] Um, so this will pick up any deductible, co-pay or co-insurance, um, for outpatient hospital services.
[CUSTOMER][NEUTRAL] Alright, so it'll pick up deductible, co-pay, and co-insurance.
[AGENT][NEUTRAL] Yes.
[CUSTOMER][POSITIVE] Alrighty thank you so much and then can I just get a reference number for the call?
[AGENT][NEUTRAL] That's my name, [PII], first initial to last name, [PII], and then today's date.
[CUSTOMER][NEUTRAL] Oh, and one more thing before I get you off the phone, can I see, um, if I can we check how much the patient has used towards that 3400?
[AGENT][NEUTRAL] Sure, let me check.
[AGENT][NEUTRAL] Uh, it looks like she's actually already used it all. 3400, yeah.
[CUSTOMER][NEUTRAL] OK, so this won't cover any of her visits?
[AGENT][NEUTRAL] Right, she's maxed out her.
[CUSTOMER][NEGATIVE] If she has another visit, it's not gonna pick up any OK.
[AGENT][POSITIVE] Correct, yeah.
[CUSTOMER][NEUTRAL] Alrighty and then it was [PII] in today's date for a reference number?
[AGENT][POSITIVE] Yes, that's correct.
[CUSTOMER][POSITIVE] Alrighty thank you so much I really appreciate it.
[AGENT][POSITIVE] Thanks for calling APL. Have a great weekend.