AccountId: 011433970860
ContactId: 057ad1ce-04a6-4ab0-9901-e14e6c1ee45f
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 356140 ms
Total Talk Time (AGENT): 173397 ms
Total Talk Time (CUSTOMER): 99485 ms
Interruptions: 2
Overall Sentiment: AGENT=1.2, CUSTOMER=0.8
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/03/03/057ad1ce-04a6-4ab0-9901-e14e6c1ee45f_20250303T14:24_UTC.wav
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[AGENT][POSITIVE] Good morning. Thank you for calling APL. This is [PII]. How can I help you?
[CUSTOMER][POSITIVE] Thank you customer service advocate.
[CUSTOMER][NEUTRAL] Hey [PII], my name is [PII]. I'm calling from Medcare Urgent Care. I needed to obtain information concerning a patient.
[AGENT][NEUTRAL] Yes.
[CUSTOMER][NEUTRAL] Eligibility and co-pay information.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] OK, [PII], you're needing eligibility and benefits for a member, is that correct?
[CUSTOMER][NEUTRAL] Yes, ma'am.
[AGENT][POSITIVE] Yes, ma'am, I can help you with those things. And [PII], what is a good callback number for you, please?
[CUSTOMER][NEUTRAL] [PII]
[AGENT][POSITIVE] Thank you. And the member's policy number, please.
[CUSTOMER][NEUTRAL] It is D as in door 43732864.
[AGENT][NEUTRAL] OK, thank you, but [PII], that is not a policy number for APL. That is a 90 degree benefit number. Do they, um, also have a policy?
[CUSTOMER][NEUTRAL] Do you need the policy or cert number?
[AGENT][NEUTRAL] Yes, ma'am, policy number?
[CUSTOMER][NEUTRAL] Yes, it's 025.
[CUSTOMER][NEUTRAL] 02596575
[AGENT][NEGATIVE] Mm, OK. Now that's too many numbers. Give me that again. That's way too many numbers.
[CUSTOMER][NEUTRAL] 0
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] 02596575
[AGENT][NEUTRAL] Mhm, mhm.
[AGENT][NEUTRAL] Mhm.
[AGENT][NEUTRAL] Oh, you must have start, OK, you must have started over and get, OK, just one moment.
[AGENT][NEUTRAL] And [PII], any information that I do provide for you today will be a verification of benefits and not a guarantee of payment. What is your patient's name and their date of birth?
[CUSTOMER][NEUTRAL] Patient's name is [PII]
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Birth date is [PII].
[AGENT][NEUTRAL] OK, thank you. So I do show that he is the subscriber on this limited benefit plan. This is not major medical insurance again, it's a limited benefit plan and the policy is active with an effective date of [PII].
[CUSTOMER][NEUTRAL] Oh
[CUSTOMER][NEUTRAL] OK, does he have urgent care benefits?
[AGENT][POSITIVE] Uh, give me just one moment and I'm gonna get that pulled up for you.
[CUSTOMER][POSITIVE] Thank you.
[AGENT][POSITIVE] You're welcome.
[CUSTOMER][NEUTRAL] Um
[CUSTOMER][NEUTRAL] Please wait on.
[AGENT][NEUTRAL] I'm sorry, it's just taking a moment to pull this up for me, [PII]. Thank you for your patience.
[CUSTOMER][NEUTRAL] That's, that's OK. Yes, ma'am.
[AGENT][NEUTRAL] OK. So on this policy, he has an outpatient sickness rider.
[AGENT][NEUTRAL] And the maximum benefit per visit is $75.
[CUSTOMER][NEUTRAL] Um.
[AGENT][NEUTRAL] Per visit and a maximum of 5 visits per calendar year.
[AGENT][NEUTRAL] As of now, he has not used any of them.
[CUSTOMER][NEUTRAL] So
[CUSTOMER][NEUTRAL] You said 5 per calendar?
[AGENT][NEUTRAL] 5 for calendar year. Mhm.
[CUSTOMER][NEUTRAL] OK, so he would just need to pay the 75.
[AGENT][NEUTRAL] We, that is what this plan pays.
[CUSTOMER][NEUTRAL] Right.
[AGENT][NEUTRAL] If approved, the maximum benefit on this plan is $75.
[CUSTOMER][POSITIVE] You're welcome.
[AGENT][NEUTRAL] Again, this is not major medical insurance, so there's not a co-pay or deductible.
[CUSTOMER][NEUTRAL] Like
[CUSTOMER][NEUTRAL] 80.
[CUSTOMER][NEUTRAL] So.
[AGENT][NEUTRAL] This plan pays specific amounts for certain services.
[AGENT][NEUTRAL] Per calendar year.
[CUSTOMER][NEUTRAL] And it pays for urgent care services or no?
[AGENT][NEUTRAL] On his policy, he has an outpatient sickness rider.
[AGENT][NEUTRAL] In which the maximum benefit per visit would be $75.
[AGENT][NEUTRAL] Whether that's an urgent care or a physician's doctor's office, and he has a max of 5 visits per calendar year.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][POSITIVE] OK, thank you so very much.
[AGENT][POSITIVE] Mhm. You are certainly very welcome. Is there anything else that I can help you with this morning?
[CUSTOMER][NEUTRAL] No, ma'am.
[AGENT][NEUTRAL] OK, well, there's 11 thing I did. It's [PII] and just so that you also know, we do have a portal, [PII], that if you will file the claim once it's been processed by APO you should be able to check claim status by going to [PII].
[CUSTOMER][NEUTRAL] And what did you say your first name was?
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][POSITIVE] All right thank you so much.
[AGENT][POSITIVE] Well you are certainly very welcome so again thank you for calling APO and I hope you have a great day.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] Um, bye-bye.
[CUSTOMER][POSITIVE] Thank you, bye bye.
[AGENT][POSITIVE] Mhm. You're welcome. Bye-bye.