AccountId: 011433970860
ContactId: 1647bd6e-d247-4215-bea1-12fd3c12ed1f
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 275670 ms
Total Talk Time (AGENT): 132355 ms
Total Talk Time (CUSTOMER): 110546 ms
Interruptions: 0
Overall Sentiment: AGENT=0.2, CUSTOMER=0.4
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/04/30/1647bd6e-d247-4215-bea1-12fd3c12ed1f_20250430T18:37_UTC.wav
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[AGENT][NEUTRAL] Afternoon. Thank you for calling APL. This is So. How may I assist you?
[CUSTOMER][NEUTRAL] Yes, my name is [PII] calling from Austin Regional Clinic, and I'm just calling in regards to a patient's plan.
[AGENT][NEUTRAL] OK, sure, um, I can assist you with information, Ms. [PII]. May I have a callback number just in case we get disconnected?
[CUSTOMER][NEUTRAL] Yes, it's gonna be a direct line of [PII].
[AGENT][NEUTRAL] All right, and thank you. And may I have um the patient's policy number?
[CUSTOMER][NEUTRAL] Yes, it shows uh D as in delta 43302307.
[AGENT][NEUTRAL] Um, that the number is not ours. Um, do you have another one or do you see another one that starts with a 0 followed by 7 digits?
[CUSTOMER][NEUTRAL] Let me double check here. OK, I see it now, uh, 02584614.
[AGENT][NEUTRAL] OK.
[AGENT][POSITIVE] OK, thank you.
[AGENT][NEUTRAL] What's the name and date of birth of the patient?
[CUSTOMER][NEUTRAL] First name is [PII] [PII].
[AGENT][NEUTRAL] Thank you. And what type of um information do you need today, Ms. [PII]?
[CUSTOMER][NEUTRAL] Yes, I was wondering, um, I was hearing through the automated. It sounded like she just might have benefits in regards to facility, um, now the patient's wanting to be seen for her pregnancy, so I wanted to see if this plan covers anything for maternity or if it's strictly just specific I guess facility charges only.
[AGENT][NEUTRAL] Got you. OK, I can help you with that. And before I give you any benefit information, I need to let you know that this is not a guarantee of payment, just a verification of coverage and that's just a disclaimer. And let's see, so this is a limited hospital indemnity plan. It does have um inpatient benefits, but it also have off office visit benefits, OK? So let me just go ahead and give you those.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] OK. So for the, um, and I'm waiting on the system. I'm so sorry. OK. So for the hospitalization or the delivery, um, it covers an admission benefit of $500 and that's one time per year, and then there's $50 daily.
[CUSTOMER][NEUTRAL] That's OK.
[AGENT][NEUTRAL] And for office visits, um, we cover $75 per visit, maximum of 4 visits.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK, max $75 per visit maximum.
[AGENT][NEUTRAL] Yes. Mhm.
[CUSTOMER][NEUTRAL] Of 4.
[CUSTOMER][NEUTRAL] OK, and then, so is that the insurance only pays up to $75 is that how that works?
[AGENT][NEUTRAL] We pay $75. They pay anything additional to the $75. This is an indemnity plan, so that's an indemnity amount.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] OK, I understand. OK.
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] And then they pay the rest, OK.
[CUSTOMER][MIXED] Perfect and then uh but other than that if it comes to um like ultrasounds or labs that would not be covered.
[AGENT][NEGATIVE] No. No, that's not covered.
[CUSTOMER][NEUTRAL] OK
[CUSTOMER][NEUTRAL] OK, that's fine thank you and then uh for the inpatient, is there any authorization required?
[AGENT][NEUTRAL] Yeah
[AGENT][NEUTRAL] No, because it's just a limited policy. Authorization is not gonna be required.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Thank you and then if I may, uh, I guess before I ask for the reference number, does she have an option to upgrade her plan or is this the only thing that would be offered?
[AGENT][NEUTRAL] [PII]
[AGENT][NEUTRAL] This is a group policy. Um, I'm not sure if the employer is offering anything differently, um, but if they do, she probably will have to call the third party.
[CUSTOMER][POSITIVE] Oh, I see. OK, that's fine, thank you. And if I may just have a reference number, thank you for your help.
[AGENT][NEUTRAL] Mhm.
[AGENT][NEUTRAL] Yeah.
[AGENT][NEUTRAL] You're welcome. We don't have reference numbers you can use my name in today's date if you will. Do you need the spelling of my name or any other information?
[CUSTOMER][NEUTRAL] Um, I'll take, if you don't mind the spelling of your name, please.
[AGENT][NEUTRAL] Sure, no problem. That's [PII].
[CUSTOMER][POSITIVE] Thank you so much you have a great day.
[AGENT][POSITIVE] You're welcome. You as well, and thank you for calling APO. Mm bye bye.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Bye bye.
[AGENT][NEUTRAL] OK.