AccountId: 011433970860
ContactId: 1e66a2d2-9b4f-47cb-a3d6-7347aa887581
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 401000 ms
Total Talk Time (AGENT): 155492 ms
Total Talk Time (CUSTOMER): 185915 ms
Interruptions: 1
Overall Sentiment: AGENT=0.4, CUSTOMER=0.9
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/06/25/1e66a2d2-9b4f-47cb-a3d6-7347aa887581_20250625T12:44_UTC.wav
--------------------------------------------
[AGENT][NEUTRAL] APL. This is [PII]. How can I help you?
[CUSTOMER][NEUTRAL] Uh, hi, good morning. Uh, my name is [PII]. I'm calling to check eligibility and benefits, please.
[AGENT][POSITIVE] OK, I'm happy to check on eligibility and benefits today, [PII]. Do you have the patient's policy number?
[CUSTOMER][POSITIVE] Oh thank you.
[CUSTOMER][NEUTRAL] Uh, yeah, I have here D as in Delta 437281117.
[AGENT][NEGATIVE] Unfortunately, I can't pull them with that number. Do you have their name or social? We can check by that?
[CUSTOMER][NEUTRAL] I have here, uh, this number works [PII].
[AGENT][NEUTRAL] Alright, let me try that. One moment.
[CUSTOMER][POSITIVE] Thank you.
[AGENT][NEUTRAL] And for documentation, do you have a good callback number?
[CUSTOMER][NEUTRAL] I do have here a direct line that is [PII].
[AGENT][NEUTRAL] Patient's name and date of birth?
[CUSTOMER][NEUTRAL] Mhm hm this is for [PII] [PII].
[AGENT][POSITIVE] Thank you. So patient is active. Effective date is [PII].
[CUSTOMER][NEUTRAL] That
[CUSTOMER][NEUTRAL] [PII] and what oh this one is active, what type of plan does this patient have?
[AGENT][NEUTRAL] This is a limited benefit hospital indemnity plan.
[CUSTOMER][NEUTRAL] Limited benefit only let me thank you. And what is the network that you utilize for this policy?
[AGENT][NEUTRAL] Mhm.
[AGENT][NEUTRAL] There's no network required for usage. The plan itself just pays a set amount depending upon what they're being seen or treated for.
[CUSTOMER][NEUTRAL] Oh, OK, so for this patient, uh, for the benefits, I'm looking for specialist office visit, allergy infection, allergy serum, and allergy testing.
[AGENT][NEUTRAL] One moment.
[CUSTOMER][NEUTRAL] If it's going to be covered under this, thank you.
[AGENT][NEUTRAL] So the patient's plan does have an outpatient benefit for an office visit, which is $75 per visit.
[AGENT][NEUTRAL] The patient is allowed a total of 5 visits in a calendar year.
[CUSTOMER][NEUTRAL] Calendar mhm.
[CUSTOMER][NEUTRAL] 5.
[AGENT][NEUTRAL] To date, yeah, patient has used 3 of their 5 visits.
[CUSTOMER][POSITIVE] Oh, OK, so only 2 remaining as of today, thank you.
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] For office visit, so for office visit, uh, plan will pay up to the $75 per visit.
[AGENT][POSITIVE] Correct.
[CUSTOMER][POSITIVE] Correct.
[CUSTOMER][NEUTRAL] Mhm. How about for LAG services, are they covered under this policy?
[AGENT][NEUTRAL] Um
[AGENT][NEGATIVE] I don't see any other additional like benefits for like testing or anything.
[CUSTOMER][NEUTRAL] Mm, so only office visit allergy services are not covered.
[AGENT][NEUTRAL] Yeah, it just has an office visit benefit. I'm not showing any other sort of testing benefit for allergies, correct?
[CUSTOMER][NEUTRAL] OK, got it. And then, as this, uh, the, so sorry, the all services will be the patient's responsibility, right? Let me just note that one.
[AGENT][NEUTRAL] Yeah, I mean, I'm not saying that it would be covered, but we don't advise on patient responsibility. That's up to the facility or provider to decide.
[CUSTOMER][NEUTRAL] Mm.
[CUSTOMER][NEUTRAL] Mm, OK, got it. And since this plan doesn't have any network like First Health, United Healthcare.
[AGENT][NEUTRAL] Mhm.
[AGENT][NEUTRAL] Right.
[CUSTOMER][NEUTRAL] No, no network at all. OK, got it. Thank you. And they think, oh, is there any group name or group number?
[AGENT][NEUTRAL] Let me see here.
[CUSTOMER][POSITIVE] Thank you.
[AGENT][NEUTRAL] Mhm.
[AGENT][NEUTRAL] The group number is gonna be 70056.
[AGENT][NEUTRAL] A group name.
[CUSTOMER][NEUTRAL] 7005.
[AGENT][NEUTRAL] Yeah.
[AGENT][NEUTRAL] Group name is Man, analysis and utilization.
[CUSTOMER][NEUTRAL] Oh, go ahead.
[CUSTOMER][NEUTRAL] Thank you. And may I also ask for the payer ID, please?
[AGENT][NEUTRAL] Uh, let me double check on this one here. One moment.
[AGENT][NEUTRAL] The payer ID for this patient's plan is 64556.
[CUSTOMER][NEUTRAL] Thank you, um, and you mentioned this, this calendar year policy, does this plan begin [PII]?
[AGENT][POSITIVE] Correct.
[CUSTOMER][NEUTRAL] OK, so this one, and, uh, may I ask what is the correct policy number? Is it the second one that I provided you, the old, old, uh, digits?
[AGENT][NEUTRAL] Uh yes, the, the 0235, use that one.
[CUSTOMER][NEUTRAL] Cause they have here.
[CUSTOMER][NEUTRAL] OK, so we need this on. Thank you. And uh, is this like a PPO type of policy?
[AGENT][NEUTRAL] Mhm.
[AGENT][NEUTRAL] No, it's just a limited benefit plan, so it's, that's why it just pays, yeah, that's that amount.
[CUSTOMER][POSITIVE] OK, got it, thank you, and that's it. Thank you so much. May I please have the, uh,
[CUSTOMER][NEUTRAL] Your name again and the reference number.
[AGENT][NEUTRAL] Yeah, call reference is my name with today's date. My name again is [PII], that's [PII]
[CUSTOMER][NEUTRAL] OK
[AGENT][NEUTRAL] Last initial is [PII], and then today's date.
[CUSTOMER][NEUTRAL] Oh, OK, thank you, [PII]. And this last question, [PII], this is APL, not IMA Inc, right?
[AGENT][NEUTRAL] Correct. Even though the, yeah, the claims for this policy do go to IMA Incorporated.
[CUSTOMER][NEUTRAL] The status.
[CUSTOMER][POSITIVE] Ah, OK, got it, got it. Thank you so much for that information, [PII]. That's it for me. Have a wonderful rest of your day. Bye.
[AGENT][POSITIVE] You're welcome.
[AGENT][NEUTRAL] Uh
[AGENT][NEUTRAL] You as well. Bye bye.