AccountId: 011433970860
ContactId: 0de21919-c268-441b-b953-e4d75146121f
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 226679 ms
Total Talk Time (AGENT): 122610 ms
Total Talk Time (CUSTOMER): 86234 ms
Interruptions: 2
Overall Sentiment: AGENT=0.9, CUSTOMER=0.1
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/06/18/0de21919-c268-441b-b953-e4d75146121f_20250618T14:31_UTC.wav
--------------------------------------------
[AGENT][POSITIVE] Thank you for contacting.
[AGENT][NEUTRAL] How may I help you?
[CUSTOMER][NEUTRAL] Yes, my name is [PII]. I'm calling from Health Services in [PII]. I'm calling to verify eligibility for a patient.
[AGENT][NEUTRAL] I can help with eligibility. What is that policy number, please?
[CUSTOMER][NEUTRAL] I have J 47600474.
[AGENT][NEUTRAL] OK, that's not one of our policy numbers. Do you have a social security number or just?
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] And are you, could you spell out the last name of the insured so I might be able to look it up that way.
[CUSTOMER][NEUTRAL] Yes.
[CUSTOMER][NEUTRAL] The last name is [PII].
[AGENT][NEUTRAL] First name?
[CUSTOMER][NEUTRAL] [PII]
[CUSTOMER][NEUTRAL] [PII]
[AGENT][NEUTRAL] And
[AGENT][NEUTRAL] Date of birth?
[CUSTOMER][NEUTRAL] [PII].
[AGENT][POSITIVE] Thank you. Is there a callback number I can handle you guys that we're disconnected?
[CUSTOMER][NEUTRAL] Ma'am.
[AGENT][NEUTRAL] Is there a callback number please in case we're disconnected?
[CUSTOMER][NEUTRAL] It's [PII].
[AGENT][NEUTRAL] Thank you the policy number for this coming into effect on [PII] is 02.
[AGENT][NEUTRAL] 63
[AGENT][NEUTRAL] 5151, that is an active policy. Is there anything else I can help you with besides eligibility?
[CUSTOMER][NEUTRAL] Yes, does she have any medical benefits under this policy?
[AGENT][NEUTRAL] This is a uh hospital indemnity policy. It picks up, or excuse me, it pays a flat rate benefit for services such as hospital admission, um, uh, ICU.
[CUSTOMER][NEUTRAL] I.
[CUSTOMER][NEUTRAL] Yeah
[AGENT][NEUTRAL] Uh, rehab, um, outpatient hospital as well, such as the ER or urgent care. Is there anything in particular that I could tell you about the policy?
[CUSTOMER][NEUTRAL] But
[CUSTOMER][NEUTRAL] I was just trying to see, does she have any coverage for uh PCP?
[AGENT][NEUTRAL] Mm
[CUSTOMER][NEUTRAL] But she went out to the car but you know.
[AGENT][NEUTRAL] Yes.
[CUSTOMER][NEUTRAL] No
[CUSTOMER][NEUTRAL] Let her know that that night.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] I'm still just checking.
[CUSTOMER][NEUTRAL] I
[CUSTOMER][POSITIVE] Hm, so good that ID.
[CUSTOMER][NEUTRAL] You know, free night no free night here.
[CUSTOMER][NEUTRAL] Uh-huh. Did you tell?
[AGENT][NEUTRAL] So, there is an office visit co-pay or an office visit, um.
[CUSTOMER][NEUTRAL] Uh
[AGENT][NEUTRAL] Uh, service. She has 2 of those throughout the calendar year. Uh, we will pay up to $250 for two office visits. That is just a verification of benefits, not a guarantee of payments.
[CUSTOMER][NEUTRAL] Uh huh.
[CUSTOMER][NEUTRAL] It I just to
[CUSTOMER][NEUTRAL] I know.
[AGENT][NEUTRAL] Um,
[AGENT][NEUTRAL] That is for the uh um I'm sorry, for surgery or treatment within the physician's office. For the office visit co-pay, she has 4 of those throughout the calendar year. We will pay up to $50 for 4 office visits throughout the calendar year, but again, the verification of benefits, not a guarantee of payment.
[CUSTOMER][NEUTRAL] Uh
[CUSTOMER][NEUTRAL] It.
[CUSTOMER][NEUTRAL] Mhm
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Mm.
[CUSTOMER][NEUTRAL] OK, and how much is the copay?
[AGENT][NEUTRAL] Well, there is no co-pay. What it does, this isn't primary insurance. What it does is it pays for, um, uh, pays a flat rate benefit for these services.
[AGENT][NEUTRAL] So it's not, it's not a copay. What it will do is, like, for example, example, the office visit, it will just pay that $50 and nothing else for treatment within the physicians got you.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] OK, so if we charge $150 it will only pay just the $50.
[AGENT][POSITIVE] Excuse me, yes, that is correct.
[CUSTOMER][NEUTRAL] OK, all right, that's all I need to know.
[AGENT][POSITIVE] OK, there's nothing else we can help with. Thank you for contacting us.
[CUSTOMER][NEUTRAL] Here you go.