AccountId: 011433970860
ContactId: 207ccdf7-ed9d-4728-8af4-748ea63fd36f
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 257928 ms
Total Talk Time (AGENT): 123304 ms
Total Talk Time (CUSTOMER): 119731 ms
Interruptions: 2
Overall Sentiment: AGENT=1.5, CUSTOMER=0.5
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/04/04/207ccdf7-ed9d-4728-8af4-748ea63fd36f_20250404T14:47_UTC.wav
--------------------------------------------
[AGENT][POSITIVE] Good morning. Thank you for calling APL. My name is [PII]. How may I help you?
[CUSTOMER][NEUTRAL] Hi [PII], I'm calling to get benefits on a patient please.
[AGENT][POSITIVE] It would be my pleasure to assist you with benefits. May I ask your name?
[CUSTOMER][NEUTRAL] My name is [PII]
[AGENT][POSITIVE] Wonderful.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] Thank you, [PII]. What is the callback number?
[CUSTOMER][NEUTRAL] [PII]
[AGENT][NEUTRAL] Thank you, and [PII], what is the policy number for the patient, please?
[CUSTOMER][NEUTRAL] Um, I have 02597089.
[AGENT][NEUTRAL] Thank you, [PII] and the patient's name and date of birth, please.
[CUSTOMER][NEUTRAL] Yes.
[CUSTOMER][NEUTRAL] It is [PII] 72682.
[AGENT][POSITIVE] All right, thank you, and it would be my pleasure to assist you with benefits for [PII]. I'm showing her policy is active. The effective date is for [PII].
[AGENT][NEUTRAL] And this is a hospital indemnity policy.
[CUSTOMER][NEUTRAL] Make sure you give me a call, OK.
[AGENT][NEUTRAL] What type of benefits are you needing?
[CUSTOMER][NEUTRAL] Um, I, I need to get PCP office visit, um, benefits including any injections, labs, minor in office surgery, and, um, preventative like routine physicals. Does she only have hospital benefits?
[AGENT][POSITIVE] Well, actually she does have office visit benefits for accident or sickness treatment.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] And we pay $75 per visit, maximum of 6 days per calendar year. That would include any.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] That would include the benefit for the visit or any procedures.
[CUSTOMER][NEUTRAL] In
[CUSTOMER][NEUTRAL] OK, so, OK.
[CUSTOMER][NEUTRAL] So any any injections, labs, anything, it covers up to $75 has she used any of the days?
[AGENT][POSITIVE] That's right. And
[AGENT][NEUTRAL] Let me check that for you.
[CUSTOMER][NEUTRAL] Hm.
[AGENT][NEUTRAL] She has not as of yet. Uh, it was just active on the first.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK, OK, oh yeah, that's right. I don't know why I go, I'll still have to sleep, uh-huh. And does she have any, yeah, does she, does she have any, uh, routine, um, like preventative, um, coverage?
[AGENT][NEUTRAL] I forgot too, so I'm like, wait, let me check.
[AGENT][NEUTRAL] And his party.
[AGENT][NEUTRAL] Hm
[AGENT][NEGATIVE] Preventative is not covered under this plan.
[CUSTOMER][NEUTRAL] Like for routine physical? OK.
[CUSTOMER][NEUTRAL] All right.
[CUSTOMER][NEUTRAL] OK, so the plan only covers up to $75. Anything else is just is, um, patients responsibility or is this subject to like an out of pocket or anything co-insurance.
[AGENT][NEUTRAL] No, there's no deductible co-pay or co-insurance on this plan. We just pay that benefit amount.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK, all right.
[CUSTOMER][NEUTRAL] Alright, can I get, um, I'm sorry, you said your name was [PII], right?
[AGENT][NEUTRAL] That's right. [PII].
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK and then can I get a reference number please?
[AGENT][NEUTRAL] It would be my name and today's date, and I, oh, I've already spelled my name. Sorry, I went on automatic and if you would please note that all benefits given over the phone is a verification of coverage, not a guarantee of payment. And [PII], is there anything else?
[CUSTOMER][NEUTRAL] OK, and then one more question, yes ma'am, what is the claims address for?
[AGENT][NEUTRAL] Sure.
[AGENT][NEUTRAL] Sure. The claim's address is [PII].
[CUSTOMER][NEUTRAL] No.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] 950.
[CUSTOMER][POSITIVE] Thank
[CUSTOMER][NEUTRAL] You said [PII]?
[AGENT][NEUTRAL] [PII].
[AGENT][NEUTRAL] Mhm. [PII].
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] [PII].
[AGENT][NEUTRAL] [PII].
[AGENT][NEUTRAL] Zip code is [PII].
[CUSTOMER][POSITIVE] All right thank you so much for your help you have a great rest of the day.
[AGENT][POSITIVE] It's been my pleasure to assist you and [PII], thank you for calling API. You have a great day as well and a happy weekend.
[CUSTOMER][POSITIVE] Thank you you too you too bye bye.
[AGENT][POSITIVE] Thank you. Bye-bye.