AccountId: 011433970860
ContactId: 10eefd5d-3d33-421d-b62c-fdee14f81663
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 226889 ms
Total Talk Time (AGENT): 82319 ms
Total Talk Time (CUSTOMER): 118028 ms
Interruptions: 0
Overall Sentiment: AGENT=0.3, CUSTOMER=0.7
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/02/07/10eefd5d-3d33-421d-b62c-fdee14f81663_20250207T22:35_UTC.wav
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[AGENT][NEUTRAL] Thank you for calling American Public Life. This is [PII]. How may I assist you?
[CUSTOMER][NEUTRAL] Hi, I'm sorry, did you say your name was [PII]?
[AGENT][NEUTRAL] It's [PII].
[CUSTOMER][NEUTRAL] Oh [PII], I'm so sorry. Thank you, Ms. [PII]. My name is [PII]. I'm calling with [PII]. Um, I'm calling to verify that a patient has active coverage, the effective date, and the type of plan that they have.
[AGENT][NEUTRAL] OK. May I please have the policy number?
[CUSTOMER][NEUTRAL] Uh yes, the policy number that the patient gave me is D like David, 43302145.
[AGENT][NEUTRAL] OK, that one's not our policy number.
[CUSTOMER][NEUTRAL] No, OK, they did give me another one, they said 02495895 or 97, excuse me.
[AGENT][NEUTRAL] So 02495897.
[CUSTOMER][NEUTRAL] Go.
[CUSTOMER][NEUTRAL] Yes.
[AGENT][NEUTRAL] OK
[AGENT][NEUTRAL] And may I please have a callback number?
[CUSTOMER][NEUTRAL] Uh yes, [PII].
[AGENT][NEUTRAL] And may I have the patient's name and date of birth?
[CUSTOMER][NEUTRAL] Uh yes, [PII]. Date of birth is [PII].
[AGENT][NEUTRAL] Thank you. And you were calling in for eligibility, benefits and type of policy?
[CUSTOMER][NEUTRAL] Uh, yeah, so, um, just the effective date of the plan and then, um, the type of plan that they have.
[AGENT][NEUTRAL] OK. So the effective date is showing [PII] and this policy is an indemnity or limited benefit policy.
[CUSTOMER][NEUTRAL] OK let me.
[CUSTOMER][NEUTRAL] OK, and then with that policy, do they have like a deductible or uh like for example um he wants to make a follow up office visit for uh orthopedics which were specialty.
[AGENT][NEUTRAL] OK, so the way that this policy works is a minimum amount that we will pay out and then if there's anything left over, then it is considered patients responsibility. So for the office visits, verification of coverage does not guarantee the payment of the claim. The member has up to $75 with the maximum of 5 visits per calendar year that we will pay.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Per calendar here.
[CUSTOMER][NEUTRAL] OK, so you guys will pay a minimum of $75 after that patient has to pay the rest and then that's up to 5 visits per calendar year you said.
[AGENT][NEUTRAL] Yes.
[CUSTOMER][NEUTRAL] OK and then does this plan require authorization for um specialty visits?
[AGENT][NEUTRAL] No office required.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK, and then what is your um uh claims mailing address, please?
[AGENT][NEUTRAL] The mailing address is [PII].
[AGENT][NEUTRAL] [PII].
[AGENT][NEUTRAL] [PII].
[AGENT][NEUTRAL] [PII].
[CUSTOMER][NEUTRAL] Alright, [PII].
[AGENT][NEUTRAL] Yes.
[CUSTOMER][POSITIVE] OK perfect thank you so much [PII] I appreciate your help.
[AGENT][POSITIVE] You're welcome. Thank you for calling American Public Life [PII] have a great day and enjoy your weekend.
[CUSTOMER][POSITIVE] You too thank you bye bye.
[AGENT][NEUTRAL] Bye.