AccountId: 011433970860
ContactId: 135f5110-366d-436b-b281-8fe70dafe710
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 195460 ms
Total Talk Time (AGENT): 90489 ms
Total Talk Time (CUSTOMER): 60259 ms
Interruptions: 0
Overall Sentiment: AGENT=0.9, CUSTOMER=0.5
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/01/16/135f5110-366d-436b-b281-8fe70dafe710_20250116T16:48_UTC.wav
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[AGENT][POSITIVE] Thank you for calling APL. This is [PII]. How can I help you?
[CUSTOMER][NEUTRAL] Hi, this is [PII]. I'm calling from Prisma Health, and I want to verify patients benefits eligibility.
[AGENT][NEUTRAL] OK ma'am, can I get a good call back number?
[CUSTOMER][NEUTRAL] [PII], no extension.
[AGENT][NEUTRAL] OK, thank you ma'am. Can I get the policy number?
[CUSTOMER][NEUTRAL] Yes, it's uh.
[CUSTOMER][NEUTRAL] D for Delta 43724159.
[AGENT][NEUTRAL] OK ma'am, that's not gonna be our policy number if you look on the front of the insurance card, it's gonna state policy certificate number.
[CUSTOMER][NEUTRAL] Um,
[CUSTOMER][NEUTRAL] Yeah, just give me one second.
[CUSTOMER][NEUTRAL] 022 00247
[AGENT][NEUTRAL] OK, 0220247?
[CUSTOMER][NEUTRAL] No, 02200247.
[AGENT][NEUTRAL] OK, thank you ma'am, can you confirm the insured's name and date of birth for me?
[CUSTOMER][NEUTRAL] [PII]. Date of birth, [PII].
[AGENT][NEUTRAL] OK, thank you and you said you're calling to confirm eligibility?
[CUSTOMER][NEUTRAL] Yes, benefits and eligibility.
[AGENT][NEUTRAL] OK, thank you. I can definitely take a look now it looks like um the insured was effective with this [PII] currently still active.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] So this will be a verification of benefits and not a guarantee of payment. Is there a certain place of service that you're looking for benefits for?
[CUSTOMER][NEUTRAL] Yes, a sick visit for primary and specialist.
[AGENT][NEUTRAL] OK, so this is a hospital indemnity limited benefit plan. The policy is an outpatient sickness rider benefit, so it does only cover sickness. So the policy is they have 5 visits per calendar year.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] And the policy will pay $75 per visit up to 5 visits per policyholder with the combined of $10 per policy.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] So it's saying.
[CUSTOMER][NEUTRAL] Insurance will pay $75 per visit, right?
[AGENT][POSITIVE] Yes ma'am, that is correct.
[CUSTOMER][NEUTRAL] And 5 how many visits remaining for this year? I mean, it just to start, I guess, but just.
[CUSTOMER][NEUTRAL] I want to make sure.
[AGENT][NEUTRAL] OK, as of today's date, any claims that we have processed there hasn't been any used.
[CUSTOMER][NEUTRAL] So 5 remaining 5. OK. And I just need uh your name and the call reference number, please.
[AGENT][NEUTRAL] OK, so the call reference number is gonna be my name. It's gonna be [PII] with the first [PII], and today's date. Is there anything else that I can help you with today?
[CUSTOMER][POSITIVE] No, thank you so much.
[AGENT][POSITIVE] OK, well thank you for calling APL and I hope you have a great day.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][POSITIVE] Thank you too.
[AGENT][NEUTRAL] All right bye bye.