AccountId: 011433970860
ContactId: 1f847b92-5722-4cdc-9e18-206d8ee53a89
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 307420 ms
Total Talk Time (AGENT): 177794 ms
Total Talk Time (CUSTOMER): 95892 ms
Interruptions: 1
Overall Sentiment: AGENT=1.1, CUSTOMER=1.3
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/01/31/1f847b92-5722-4cdc-9e18-206d8ee53a89_20250131T16:55_UTC.wav
--------------------------------------------
[AGENT][NEUTRAL] Thank you for calling APL. This is [PII] speaking. How may I help you?
[CUSTOMER][NEUTRAL] Hi [PII], my name's [PII]. I'm calling from AdventHealth Carolwood to verify benefits for an individual. I spoke with 90 Degree Benefits who handles her wellness, um, and they stated you should be able to help me look up her medical at this number.
[AGENT][POSITIVE] Certainly I'll be happy to help you with benefits [PII]. Can I please have a callback number in case we get disconnected?
[CUSTOMER][NEUTRAL] Sure, it's
[CUSTOMER][NEUTRAL] Uh huh it's [PII].
[AGENT][NEUTRAL] Thank you and do you have that member policy uh certificate number?
[CUSTOMER][NEUTRAL] Uh
[CUSTOMER][NEGATIVE] I do not. The one I have is for her wellness, not for medical.
[AGENT][NEUTRAL] OK, so do you have a social security number or we'll search by name if not?
[CUSTOMER][NEUTRAL] Let's see, I do not have a social, so let's try by name.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] It is [PII] and that is spelled [PII]
[CUSTOMER][NEUTRAL] And [PII]
[AGENT][POSITIVE] Thank you.
[AGENT][NEUTRAL] And what city and state uh does [PII] reside in?
[CUSTOMER][NEUTRAL] It is in [PII].
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] And can you please verify date of birth for Miss [PII]?
[CUSTOMER][NEUTRAL] Her date of birth is [PII].
[AGENT][POSITIVE] OK, thank you.
[AGENT][NEUTRAL] And just give me one moment. I do have a policy here for.
[AGENT][NEUTRAL] Miss [PII], so give me just one moment while I pull that information forward and just to let you know it is a verification of coverage and not a guarantee of payment.
[CUSTOMER][POSITIVE] Thank you.
[CUSTOMER][NEUTRAL] Yes ma'am.
[AGENT][NEUTRAL] And did you need that eligibility uh date as well, [PII]?
[CUSTOMER][POSITIVE] Uh, yes, yes, if you would please.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] Certainly.
[AGENT][NEUTRAL] OK, so I show the policy is active.
[AGENT][NEUTRAL] The effective date is [PII].
[AGENT][NEUTRAL] And I'm just gonna make sure there's no additional policies prior to that date and there's not so that [PII] is that effective date and can you tell me what type of benefits you're needing? Is it inpatient, outpatient?
[CUSTOMER][NEUTRAL] Outpatient looks like she's coming in for a biopsy.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] And this would be in the facility or um in the oh OK alright great thank you just give me one moment please.
[CUSTOMER][NEUTRAL] Yes ma'am.
[CUSTOMER][NEUTRAL] Sure.
[AGENT][NEUTRAL] And so this would be uh outpatient hospital or free standing outpatient surgery center?
[CUSTOMER][NEUTRAL] Uh, yes, outpatient hospital.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] So then outpatient benefit, uh, [PII], she has a, um, accident and sickness surgery benefit. So this policy is a limited medical hospital indemnity, so it does have limited medical benefits. Now, um, under this policy for that accident and sickness surgery benefit, and what that means is just it would be in the event of a diagnosis for an accident or injury or a sickness illness, um, either one. So that, um, that benefit for surgery.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] Um, it's an outpatient benefit of $500.
[AGENT][NEUTRAL] Um, and that's one, day per person per calendar year.
[AGENT][NEUTRAL] So that would be the maximum benefit allowed under the surgery benefit.
[CUSTOMER][POSITIVE] OK, thank you.
[CUSTOMER][NEUTRAL] OK, now is she, does she have a plan to where she could make that a better plan? Can she upgrade it?
[AGENT][NEUTRAL] Unfortunately no it's, it's she signs up right through her employer. Do you happen to know um do you, does your facility participate with multi plan?
[CUSTOMER][NEUTRAL] Or is that what it is?
[CUSTOMER][POSITIVE] Yeah we do.
[AGENT][NEUTRAL] OK, because they are encouraged to use multi plan providers, um, in the event that you know because they are it is kind of, it's not, it doesn't take the place of a comprehensive major medical insurance it is just limited indemnity.
[CUSTOMER][NEUTRAL] Right.
[CUSTOMER][NEUTRAL] Right.
[CUSTOMER][NEUTRAL] Correct, OK, and then can you give me her medical ID number?
[AGENT][NEUTRAL] Certainly so the.
[CUSTOMER][NEUTRAL] I have the one for wellness but not for medical.
[AGENT][NEUTRAL] Yeah, and that's the the starts with the D character correct?
[CUSTOMER][NEUTRAL] Yeah mhm.
[AGENT][NEUTRAL] Yeah, OK, so her policy certificate, um, with us, I can give you that number and again um it is 02.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] 57
[AGENT][NEUTRAL] 4120.
[CUSTOMER][NEUTRAL] Thank you and then [PII], is there a reference number for this call today?
[AGENT][POSITIVE] Certainly the call reference number [PII] is my name and today's date and it's [PII].
[CUSTOMER][POSITIVE] Thank you.
[CUSTOMER][POSITIVE] Alright thank you so much [PII] I appreciate your help.
[AGENT][POSITIVE] You're welcome, [PII]. Thank you so much for calling APL. I hope you have a great rest of your day and a great weekend.
[CUSTOMER][POSITIVE] Thanks you too you too hon bye bye.
[AGENT][POSITIVE] Thank you.