AccountId: 011433970860
ContactId: 045c29a9-1c6d-4e59-8f9d-24873bb6e01d
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 266450 ms
Total Talk Time (AGENT): 114400 ms
Total Talk Time (CUSTOMER): 114714 ms
Interruptions: 0
Overall Sentiment: AGENT=1.1, CUSTOMER=0.1
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/02/18/045c29a9-1c6d-4e59-8f9d-24873bb6e01d_20250218T22:12_UTC.wav
--------------------------------------------
[AGENT][POSITIVE] Good afternoon. Thank you for calling APL. My name is [PII]. How may I help you?
[CUSTOMER][NEUTRAL] Hi, um, my name is [PII] and I'm calling from Multi Care Health Systems. I just need to check eligibility for a patient.
[AGENT][POSITIVE] OK, well, I'll be more than happy to help you with the eligibility. And [PII], may I have a good contact number in case we're disconnected?
[CUSTOMER][NEUTRAL] Uh yes, it's [PII].
[AGENT][NEUTRAL] Thank you for that. And may I have the member's policy number?
[CUSTOMER][NEUTRAL] I have 0256500007.
[AGENT][NEUTRAL] Thank you, hold on one moment.
[AGENT][NEUTRAL] And can you verify the member's first and last name and date of birth?
[CUSTOMER][NEUTRAL] Um, I have the last name is [PII]. The first name is a weird one. It's a
[CUSTOMER][NEUTRAL] [PII]
[CUSTOMER][NEUTRAL] [PII]
[CUSTOMER][NEUTRAL] 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. I am showing the policy is active. It's been effective since [PII].
[AGENT][NEUTRAL] And did you want to go over any benefits today?
[CUSTOMER][NEUTRAL] Um, I just have that this is just a limited benefit plan.
[AGENT][NEUTRAL] Yes, this is a hospital indemnity policy. However, it does have additional benefits. Were you looking for a specific like an office or anything?
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Yeah let me look and see what this says here um.
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Uh, oh, of course this is a.
[CUSTOMER][NEUTRAL] This looks like it's radiation therapy.
[AGENT][NEUTRAL] Wait, so is this for like cancer treatment?
[CUSTOMER][NEUTRAL] Let me look here.
[AGENT][NEUTRAL] Because let me see if they had, hold on one second.
[CUSTOMER][NEUTRAL] Yeah, the diagnosis here is malignant neoplasm of, OK, breast cancer. It says encounter for anti neoplastic radiation therapy.
[AGENT][NEUTRAL] OK, wait a second, hold on one moment.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] I mean she does have other coverage. She has a an uh a Medicaid plan.
[AGENT][NEUTRAL] OK. No, the only reason I was asking because this is, I was looking to see if they had like a cancer policy, but I didn't see one. Now, on this policy, I mean, they would be able to use like if if if she was admitted to the hospital, there's coverage for the admission benefit, um.
[CUSTOMER][NEUTRAL] Uh-huh.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] Any, let me see, I'm trying to make it bigger. Hold on one second. If she's confined to the hospital, um, 30 days per calendar year, she has, there's coverage for that, diagnostic testing, so this might be in addition to
[CUSTOMER][NEUTRAL] OK, well this is just outpatient.
[CUSTOMER][NEUTRAL] Just outpatient
[CUSTOMER][NEUTRAL] But I mean this is actually a past service like her other insurance has paid it but she does have a bunch of stuff that's scheduled coming up um.
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] So that's why I was kinda.
[AGENT][NEUTRAL] In the air.
[CUSTOMER][NEUTRAL] Yeah
[AGENT][NEUTRAL] So for the hospital indemnity policy, it depends. I would still say to file the claim because she does have those additional benefits on here. So if anything does apply, they would use it.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] And you said 11:25.
[CUSTOMER][NEUTRAL] So I got yeah OK.
[AGENT][POSITIVE] 11:25, yes, it became um effective.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK, we'll file it and then well I guess the worst that can happen is you can say no, um.
[CUSTOMER][NEUTRAL] Let's see here, let me make sure I've got the right billing information. I have, I have a copy of the card, uh, [PII].
[AGENT][NEUTRAL] Yes, [PII], yes, ma'am.
[CUSTOMER][NEUTRAL] Yep, OK.
[CUSTOMER][NEUTRAL] I will do it.
[AGENT][NEUTRAL] All right, [PII], was there anything else I can help you with today?
[CUSTOMER][NEUTRAL] All right
[CUSTOMER][NEUTRAL] Uh, no, is there a call reference number?
[AGENT][NEUTRAL] There is no call reference number, but you can use my name in today's date, and again, that's [PII], first initial to my last name is [PII].
[CUSTOMER][POSITIVE] OK sounds good all right thank you.
[AGENT][POSITIVE] Alrighty, well, you're welcome. Thanks for calling APL. Bye-bye.
[CUSTOMER][NEUTRAL] Uh huh bye bye.