AccountId: 011433970860
ContactId: 333b9f2e-f4f0-4e25-af1c-878576b24db9
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 296380 ms
Total Talk Time (AGENT): 146661 ms
Total Talk Time (CUSTOMER): 82118 ms
Interruptions: 2
Overall Sentiment: AGENT=1.4, CUSTOMER=1.3
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/02/20/333b9f2e-f4f0-4e25-af1c-878576b24db9_20250220T14:21_UTC.wav
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[AGENT][NEUTRAL] Thank you for calling APL. This is [PII]. How can I help you?
[CUSTOMER][NEUTRAL] Good morning [PII]. My name is [PII] with Bluegrass Orthopedics, and we've got a patient in our office right now that has given this information as a secondary, and I wanted to verify this. I've never heard of this insurance.
[AGENT][POSITIVE] Yes, may help.
[AGENT][NEUTRAL] OK, [PII], so you're needing eligibility and benefits for a member or just eligibility?
[CUSTOMER][NEUTRAL] Um, eligibility.
[AGENT][POSITIVE] Yes, ma'am. I can help you with that. And [PII], what is your callback number?
[CUSTOMER][NEUTRAL] [PII] [PII].
[AGENT][NEUTRAL] Thank you and the member's policy number please, [PII]?
[CUSTOMER][NEUTRAL] OK, policy number, I have um 02584623.
[AGENT][POSITIVE] Thank you one moment please.
[AGENT][NEUTRAL] Just one moment please [PII].
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] OK, [PII], any information that I do provide for you 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] [PII] and date of birth is [PII].
[AGENT][POSITIVE] OK, thank you.
[CUSTOMER][POSITIVE] You're welcome.
[AGENT][NEUTRAL] OK, so I do show that she is the spouse of the subscriber on this limited benefit plan and this policy is active with an effective date of [PII].
[CUSTOMER][NEUTRAL] OK, now, is this just a hospital only plan?
[AGENT][NEUTRAL] OK. No, it is not. They do have other benefits on this limited benefit plan. Are you needing benefit information?
[CUSTOMER][NEUTRAL] Let me just go ahead and just to be safe because I can't enter that in unless I know and then it also has multi plan and I know that we're not in network with multi plan, yes.
[AGENT][NEUTRAL] Multiplan is the network.
[CUSTOMER][NEUTRAL] OK, so yeah, if you could, I hate to do that, but if you can go ahead and give me benefits and if you could tell me for a network with this insurance.
[AGENT][NEUTRAL] OK, so if the plan, the network it that affili is affiliated with her policy is multiplan.
[CUSTOMER][POSITIVE] Yeah and I'm almost positive we are not in network with multi plans.
[AGENT][NEUTRAL] So if you have questions, yes ma'am, there should be a number for multi plan on the ID card, but I can also give it to you and connect you with him if you have any questions regarding that.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] OK, so just a moment for me to get her benefit information.
[AGENT][NEUTRAL] Are you needing benefits for inpatient, outpatient, or office visit?
[CUSTOMER][NEUTRAL] Just office visit.
[AGENT][NEUTRAL] OK, so one moment.
[AGENT][NEUTRAL] OK, so on this policy there is an outpatient sickness benefit, uh, which is a maximum of $75 per visit and a maximum of 5 visits per calendar year per covered person.
[CUSTOMER][NEUTRAL] OK, 75 maximum of 5 visits.
[AGENT][POSITIVE] That is correct.
[AGENT][NEUTRAL] $75 per visit and a maximum of 5 visits per calendar year.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Calendar year OK.
[AGENT][NEUTRAL] Yes, ma'am.
[CUSTOMER][NEUTRAL] All right and.
[CUSTOMER][NEUTRAL] I guess if you can go ahead and send me over to the other.
[CUSTOMER][NEUTRAL] Number
[CUSTOMER][POSITIVE] Because I think that's all that I need from this one.
[AGENT][NEUTRAL] OK, and then
[CUSTOMER][NEUTRAL] Oh, and a reference number for the call.
[AGENT][NEUTRAL] Sure, you would use my name along with today's date is your call reference number and then once the claim has been processed, we do have a portal that you should also be able to check claim status in and that portal website, [PII] is located at [PII].
[CUSTOMER][POSITIVE] Thank you.
[CUSTOMER][NEUTRAL] [PII]. OK, [PII], OK.
[AGENT][NEUTRAL] Uh-huh, and then the phone number.
[AGENT][NEUTRAL] Yes ma'am, and the phone number for multi plan should we get disconnected for some reason is [PII].
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][POSITIVE] OK, thank you.
[AGENT][POSITIVE] OK, well, you're very welcome. So again, if that is all I can help you with, thank you for calling APL. I hope you have a great day and if you'll give me one moment, I will connect you with him.
[CUSTOMER][POSITIVE] Alright thank you.
[AGENT][POSITIVE] You're welcome. Bye-bye.