AccountId: 011433970860
ContactId: 1a288eb2-8c96-42ad-83e9-6d6a1e82ea3d
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 294109 ms
Total Talk Time (AGENT): 144712 ms
Total Talk Time (CUSTOMER): 63744 ms
Interruptions: 0
Overall Sentiment: AGENT=0.6, CUSTOMER=0.7
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/06/16/1a288eb2-8c96-42ad-83e9-6d6a1e82ea3d_20250616T19:07_UTC.wav
--------------------------------------------
[AGENT][NEUTRAL] Good afternoon. Thank you for calling APL. This is [PII]. How may I help you today?
[CUSTOMER][NEUTRAL] Hi, good good afternoon. This is [PII], just calling to obtain eligibility and benefits on the member.
[AGENT][POSITIVE] All right, [PII], I'll be glad to help you. Go ahead and give me a good policy number.
[CUSTOMER][NEUTRAL] Yes, um, let's see.
[CUSTOMER][NEUTRAL] It's gonna be 026.
[CUSTOMER][NEUTRAL] 06091.
[AGENT][NEUTRAL] Alright, [PII], thank you for that information. Now while I'm pulling this up, go ahead and give me a good return telephone call number please, ma'am.
[CUSTOMER][NEUTRAL] Yes, [PII].
[AGENT][NEUTRAL] Alright, [PII], thank you for all that information. Now your patient's name and date of birth.
[CUSTOMER][NEUTRAL] [PII]. Date of birth is [PII].
[AGENT][NEUTRAL] All right. Give me that policy number one more time. I think I keyed it in wrong.
[CUSTOMER][NEUTRAL] OK, no problem. Um, 0.
[CUSTOMER][NEUTRAL] Sorry, 026.
[CUSTOMER][NEUTRAL] 06091.
[AGENT][NEUTRAL] OK, that come up. I guess I'm transposing my numbers. OK, thank you for all of the information, [PII]. Let me get it pulled up.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] OK, it looks like [PII] is the insured on this hospital indemnity plan. I do show the original effective date is [PII]. patient is current and active, but I must advise that verification of coverage is not a guarantee your payment on the claim, but what you said did say you want benefits, is that correct?
[CUSTOMER][NEUTRAL] Yes.
[AGENT][NEUTRAL] And what type of benefit are you needing today, [PII]?
[CUSTOMER][NEUTRAL] Um, yes, it will be for, uh, general benefits for, um, a specialist office visit, DME and X-ray stunning office.
[AGENT][NEUTRAL] Well let's see.
[AGENT][NEUTRAL] Give me just a moment to get that benefit pack pulled up. Let's see.
[AGENT][NEGATIVE] Oh, but it looks like now there's no DMA benefit here at all under this hospital indemnity plan.
[AGENT][NEUTRAL] And you did say office visit, is that correct?
[CUSTOMER][NEUTRAL] Yes, a specialist office visit.
[AGENT][NEUTRAL] Let me see if they have that.
[AGENT][NEUTRAL] Yeah, but it looks like they have 56 office visits payable per.
[AGENT][NEUTRAL] Calendar year and we pay a max payment of $75. Let me see how many she's used, see if she has any left, so hang on, let's see.
[AGENT][NEUTRAL] It's like as of today she's used 3 of course I can state these benefits but cannot guarantee payments so as of today though she has 1 office visit left.
[CUSTOMER][NEUTRAL] And you said she had 5 per year?
[AGENT][NEUTRAL] Yes ma'am. I mean, yes ma'am. I'm sorry too. She has 2 left. I don't know what I'm thinking.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] Yes.
[CUSTOMER][POSITIVE] OK, no, no worries.
[CUSTOMER][NEUTRAL] And what about for X-ray? Any coverage for x-rays?
[AGENT][NEUTRAL] Uh, the same for X-rays that would fall under that, um, 5 per calendar year benefit.
[AGENT][NEUTRAL] No matter what it's done.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][POSITIVE] All right. Well, thank you so much for your help.
[AGENT][NEUTRAL] All right.
[AGENT][NEUTRAL] Well, yes, ma'am, [PII].
[CUSTOMER][NEUTRAL] Um, can I just get a reference number?
[AGENT][NEUTRAL] Well, is that all I can help you with?
[CUSTOMER][NEUTRAL] Yes, ma'am.
[AGENT][NEUTRAL] All right, well, we don't give reference number, [PII], but you can use my name in today's date if you need to do so, and my name is [PII]
[CUSTOMER][POSITIVE] All right. Thank you so much for that.
[AGENT][POSITIVE] Yes, ma'am, and you have a great day, [PII], and thanks for calling APL.
[CUSTOMER][NEUTRAL] You too. Bye-bye.
[AGENT][POSITIVE] Thank you, ma'am. Bye-bye.