AccountId: 011433970860
ContactId: 1dd1003e-e136-4e90-a6a1-c84918948a5b
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 317690 ms
Total Talk Time (AGENT): 103141 ms
Total Talk Time (CUSTOMER): 103074 ms
Interruptions: 0
Overall Sentiment: AGENT=1, CUSTOMER=0.8
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/04/10/1dd1003e-e136-4e90-a6a1-c84918948a5b_20250410T14:43_UTC.wav
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[AGENT][NEUTRAL] Thank you for calling APR. This is [PII]. How can I help you?
[CUSTOMER][NEUTRAL] Hi, yes, this is [PII] calling from Prime West Health, and I was trying to verify if um what type of coverage this member has.
[AGENT][NEUTRAL] I'm sure, [PII], I can assist you with benefits. Um, first, I'll need to go callback number just in case we're disconnected.
[CUSTOMER][NEUTRAL] [PII] and my extension is [PII].
[AGENT][NEUTRAL] OK. Thank you. Now I need the policy number, please.
[CUSTOMER][NEUTRAL] OK, for that, we have D as in David, 43222881.
[AGENT][NEUTRAL] OK, that's not one of our policy numbers. Um, do you have the member's name or social? I can look them up that way.
[CUSTOMER][NEUTRAL] Um, the social we have is [PII].
[CUSTOMER][NEUTRAL] [PII]
[AGENT][NEUTRAL] OK, one moment please.
[AGENT][NEUTRAL] OK, and please verify uh the patient's name and date of birth.
[CUSTOMER][NEUTRAL] Um, I have the subscriber as [PII]. Date of birth [PII].
[AGENT][NEUTRAL] OK, and yes, ma'am. Just let me advise you that verification of coverage does not guarantee payment of claims. Um, I have a policy number here if you need that.
[CUSTOMER][POSITIVE] That would be great thank you.
[AGENT][NEUTRAL] Mhm. No problem. Um, the policy number is 02.
[AGENT][NEUTRAL] 559705.
[CUSTOMER][NEUTRAL] 02559705. OK. And when did it become effective?
[AGENT][NEUTRAL] Yes, ma'am.
[AGENT][NEUTRAL] Can the effective date was [PII]. The policy is still active and is this for inpatient or outpatient benefits or an office visit?
[CUSTOMER][NEUTRAL] Uh, this is for an office visit.
[AGENT][NEUTRAL] OK. This is a limited hospital indemnity plan, um, but we do have some outpatient benefits under this policy. And let's see, for office visits, we cover up to $4 per calendar year and we cover up to $50 per visit.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] And um is her daughter [PII].
[CUSTOMER][NEUTRAL] Um, I can give you her date of birth here. [PII], date of birth [PII]. Is she also covered on that plan?
[AGENT][POSITIVE] Yes, ma'am. I show coverage for her also.
[CUSTOMER][NEUTRAL] OK, with that same effective date.
[AGENT][POSITIVE] Yes, ma'am, and the same benefits. That's correct.
[CUSTOMER][NEUTRAL] OK
[CUSTOMER][NEUTRAL] Alright, and that's for per calendar year per member or for the whole family?
[AGENT][NEUTRAL] Per member.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Alright and then.
[CUSTOMER][NEUTRAL] And does this have any kind of pharmacy coverage with it?
[AGENT][NEUTRAL] Um, no, ma'am, it doesn't.
[CUSTOMER][NEGATIVE] No worx coverage right.
[CUSTOMER][POSITIVE] Perfect. I thank you so much for your help and I hope you have a wonderful day.
[AGENT][NEUTRAL] OK. Is there anything else I can assist you with?
[CUSTOMER][NEUTRAL] Nope, not at this time.
[AGENT][NEUTRAL] OK, and I think, oh, well, actually, for prescriptions, um, I do see some coverage on here. One moment, let me get that pulled up.
[AGENT][POSITIVE] I apologize. It just caught my eye.
[CUSTOMER][NEUTRAL] That's OK.
[AGENT][NEUTRAL] Mm
[AGENT][POSITIVE] Thank you.
[AGENT][NEUTRAL] OK, for a prescription, it's showing, um, let's see, $10 per day and a maximum of 15 days per calendar year per covered person.
[CUSTOMER][POSITIVE] 15 days. OK, perfect, thank you so much again you have a great day.
[AGENT][NEUTRAL] You do the same, [PII]. Thank you for calling ATL, bye.
[CUSTOMER][POSITIVE] Thanks. Bye.