AccountId: 011433970860
ContactId: 2c25270d-ce0c-4222-95fa-fba9c768f4d8
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 239460 ms
Total Talk Time (AGENT): 122878 ms
Total Talk Time (CUSTOMER): 73204 ms
Interruptions: 2
Overall Sentiment: AGENT=0.7, CUSTOMER=0.4
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/03/10/2c25270d-ce0c-4222-95fa-fba9c768f4d8_20250310T18:14_UTC.wav
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[AGENT][NEUTRAL] Afternoon. Thank you for calling APL. This is [PII]. How can I help you?
[CUSTOMER][NEUTRAL] Hi [PII]. Hi, this is [PII] with Memorial Herman Medical Group. I need to verify, um, benefits or get um benefits on a, on a member.
[AGENT][NEUTRAL] OK
[AGENT][NEUTRAL] OK, you're needing eligibility and benefits for it or strictly just benefits only?
[CUSTOMER][NEUTRAL] Correct, no, both, both.
[AGENT][NEUTRAL] Yes, OK, I can help you with that and what is your callback number, please?
[CUSTOMER][NEUTRAL] It is [PII].
[AGENT][NEUTRAL] Thank you. And member's policy number, [PII]?
[CUSTOMER][NEUTRAL] It is um 02538548.
[AGENT][POSITIVE] Thank you. One moment, please.
[AGENT][NEUTRAL] And [PII], any information that I do provide today would be a verification of benefits and not a guarantee of payment. What is your patient's name and date of birth?
[CUSTOMER][NEUTRAL] Patient's name is [PII]. Date of birth is [PII].
[AGENT][NEUTRAL] OK, thank you. One moment.
[AGENT][NEUTRAL] OK, so I do show that she is the spouse of the subscriber on this limited benefit plan and it is active with an effective date of [PII].
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] And what type of benefit information do you need for her inpatient, outpatient or office?
[CUSTOMER][NEUTRAL] It's uh in office um primary care.
[AGENT][NEUTRAL] OK, one moment.
[CUSTOMER][NEUTRAL] And then also if they have any preventative benefits like their yearly physical.
[AGENT][NEUTRAL] OK. So this is a limited benefit plan on this uh policy. There are not any benefits for wellness or
[CUSTOMER][NEUTRAL] OK
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] And an outpatient visit related to accident or sickness for a physician's office is the benefit amount is $75 per day, maximum of 6 days per calendar year for covered person.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] And has um she used any of them?
[AGENT][NEUTRAL] As of now, no ma'am.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] And what about telehealth? Do, is there any telehealth benefits?
[AGENT][NEUTRAL] No, ma'am, there is not.
[CUSTOMER][NEUTRAL] No, no telehealth? OK.
[AGENT][NEGATIVE] If it's billable it would fall under the visit.
[CUSTOMER][NEUTRAL] Under visits only OK.
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Alright [PII] thank you do you give a reference number?
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] Sure, you would use my name along with today's date and if you all end up filing a claim with us, [PII] for this number once the claim has been processed, we do have an out excuse me, a portal that you should be able to check our claim status in and our website for the portal is secured. [PII].
[CUSTOMER][POSITIVE] All right thank you.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] To
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] OK, and is this, are we able to verify through that um website or is it just for benefit? is it just for um for claims? OK, alright, OK, thank you [PII], thank you.
[AGENT][NEUTRAL] No, ma'am. That's just for claim status. Uh-huh. Yes, ma'am.
[AGENT][POSITIVE] OK. Well, you are very welcome. So if that is all I can help you with, thank you again for calling APO and I hope you have a great afternoon, [PII].
[CUSTOMER][POSITIVE] You do the same thank you bye bye.
[AGENT][POSITIVE] Thank you. Bye bye.