AccountId: 011433970860
ContactId: 2d8d3745-ed28-4ffe-8083-0e0a0ce1b3ff
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 265970 ms
Total Talk Time (AGENT): 140245 ms
Total Talk Time (CUSTOMER): 84175 ms
Interruptions: 0
Overall Sentiment: AGENT=0.5, CUSTOMER=0.6
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/01/07/2d8d3745-ed28-4ffe-8083-0e0a0ce1b3ff_20250107T16:32_UTC.wav
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[AGENT][NEUTRAL] Morning, thank you for calling APL. This is [PII]. How may I assist you?
[CUSTOMER][NEUTRAL] Hi, my name is [PII]. I'm calling from a provider's office. I'm calling to get in network participation, uh, for benefits.
[AGENT][NEUTRAL] OK, um, sure, I can assist you, Miss [PII]. May I have a callback number just in case we get disconnected?
[CUSTOMER][NEUTRAL] Yes, it is [PII].
[AGENT][NEUTRAL] Thank you. And do you have a policy number for me?
[CUSTOMER][NEUTRAL] Yes, it is going to be 02504633.
[AGENT][NEUTRAL] May I have the name and date of birth of the patient?
[CUSTOMER][NEUTRAL] [PII] and it is [PII].
[AGENT][NEUTRAL] OK, that's not who I pulled up. Can you repeat that number one more time?
[CUSTOMER][NEUTRAL] 02504633.
[AGENT][NEUTRAL] Oh, that is what I have um.
[CUSTOMER][NEUTRAL] I'm sorry, that's the wrong policy number it is 02583654.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] Alright, yes, that sounds more like it. OK, um, give me just a second, let me, uh, write this down.
[AGENT][NEUTRAL] OK, thank you. All right, and um you said you're calling for network information?
[CUSTOMER][NEUTRAL] Yes, I'm calling to see if my provider is in network and then also to verify um medical benefits.
[AGENT][NEUTRAL] OK, well, this particular policy is one of our limited hospital indemnity plans. Um, with this one, if the provider participates with multi-plan, they can get that additional discount but it is not required. We're not, um, there's no network.
[AGENT][NEUTRAL] Um,
[CUSTOMER][NEUTRAL] I'm sorry, your phone was breaking up. I, I didn't hear any of that.
[AGENT][NEUTRAL] OK, let me repeat again.
[AGENT][NEUTRAL] This policy is one of our hospital indemnity plan, which is a limited policy.
[CUSTOMER][NEUTRAL] Mm
[CUSTOMER][NEUTRAL] Mhm
[AGENT][NEUTRAL] If the provider participates for multi-plan,
[AGENT][POSITIVE] They can get an additional discount.
[AGENT][NEUTRAL] But it is not required. There's no network.
[CUSTOMER][NEUTRAL] OK, so if the provider participates in multi plan.
[AGENT][NEUTRAL] With mobile plan.
[CUSTOMER][NEUTRAL] The
[AGENT][NEUTRAL] The member can get that additional desk.
[CUSTOMER][NEUTRAL] The member or the.
[CUSTOMER][NEUTRAL] The member gets a discount.
[AGENT][NEUTRAL] The mhm yeah if the provider participates with multi plan, the member will get that additional discount, but if not, it's fine because we're not, we don't have any networks.
[CUSTOMER][NEUTRAL] OK, would you be able to tell me like an office copay?
[AGENT][NEUTRAL] A visit. OK, and this is not a guarantee of payment, just a verification of coverage and that's the disclaimer.
[AGENT][NEUTRAL] And this one pays an indemnity amount which is a flat amount, anything over member's responsibility, OK? Alright, so for an office visit or office procedures, um, the benefit is $100 and that is maximum of 4 visits per covered person per calendar year.
[CUSTOMER][NEUTRAL] OK, and what about a specialist copay?
[AGENT][NEUTRAL] Is the same. That's for a PCP or a specialist. Mhm.
[CUSTOMER][NEUTRAL] Same.
[AGENT][POSITIVE] Combined benefits.
[CUSTOMER][NEUTRAL] OK, and are you able to see how many visits they've accumulated this year or has it reset for the new year?
[AGENT][NEUTRAL] It's
[AGENT][NEUTRAL] I reset for the new year.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK perfect do you have a call reference number for today?
[AGENT][NEUTRAL] We don't have reference numbers. You can use my name in today's date if you will. Do you need the spelling of my name or any other information, Miss [PII]?
[CUSTOMER][NEUTRAL] Yes, the spelling of your name please?
[AGENT][NEUTRAL] Sure. That's [PII]. Last initial is [PII].
[CUSTOMER][POSITIVE] OK perfect thank you so much for your help.
[AGENT][POSITIVE] You're welcome and thank you for calling ATL. Have a good day.
[CUSTOMER][POSITIVE] Thank you you as well bye bye.
[AGENT][NEUTRAL] No.