AccountId: 011433970860
ContactId: 3392c867-62a2-4f15-9c28-f058de201643
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 241429 ms
Total Talk Time (AGENT): 116438 ms
Total Talk Time (CUSTOMER): 107129 ms
Interruptions: 2
Overall Sentiment: AGENT=0.7, CUSTOMER=1.3
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/03/05/3392c867-62a2-4f15-9c28-f058de201643_20250305T16:10_UTC.wav
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[CUSTOMER][NEUTRAL] Say anything it said anything.
[AGENT][NEUTRAL] Thank you for calling HL. This is [PII]. How can I help you?
[CUSTOMER][NEUTRAL] Hi, good morning. I'm calling from the physician office to verify a patient's benefits.
[AGENT][POSITIVE] Sure, I can take those benefits for you uh what was your name?
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] OK, just can I get a good call back number from you in case we're disconnected?
[CUSTOMER][NEUTRAL] It
[CUSTOMER][NEUTRAL] Sure, [PII].
[AGENT][NEUTRAL] OK thank you and then do you have the policy number?
[CUSTOMER][NEUTRAL] Yeah, it's 02063660 ML 8.
[AGENT][NEUTRAL] OK, and then what was the name and date of birth for the insured?
[CUSTOMER][NEUTRAL] [PII] and her last name [PII] [PII].
[AGENT][NEUTRAL] Perfect, thank you for verifying that. uh, so the policy is active effective date was [PII], and this is a secondary medical policy, so it is designed to help with co-pay, deductible and co-insurance after major medical pays and when we needing to look at the outpatient benefit or inpatient?
[CUSTOMER][NEUTRAL] Yeah
[CUSTOMER][NEUTRAL] Uh, well, actually both for outpatient, um, I would say for office visit everything done in office if it's covered and then if she has inpatient benefits as well.
[AGENT][NEUTRAL] Oh sure.
[AGENT][NEUTRAL] OK absolutely so of course I will let you know verification of coverage is not a guarantee of payment for claims. So as far as office visits are concerned, the visits themselves are not covered. However, treatment received in office is covered under their outpatient benefit and the outpatient benefit is on a per calendar day basis, so it pays up to $500 max per calendar day.
[CUSTOMER][NEUTRAL] the
[CUSTOMER][NEUTRAL] Per calendar day $5000.
[AGENT][NEUTRAL] Uh, 500 per calendar day.
[CUSTOMER][NEUTRAL] 0 500 per calendar day.
[AGENT][NEUTRAL] Yes.
[AGENT][NEUTRAL] Yes, uh, no yearly maximum, um, give me just a moment to verify the inpatient benefits for you, of course.
[CUSTOMER][POSITIVE] Thank you.
[CUSTOMER][NEUTRAL] And then I just click OK for work and I just it over there let me let me.
[CUSTOMER][NEUTRAL] [PII], can I have the keys for.
[CUSTOMER][NEUTRAL] like coffee.
[CUSTOMER][POSITIVE] Thank
[CUSTOMER][NEUTRAL] I
[CUSTOMER][NEUTRAL] Yes
[AGENT][NEUTRAL] Bear with me just a moment it's thinking about it sorry.
[CUSTOMER][POSITIVE] No problem thank you no problem.
[CUSTOMER][NEUTRAL] Mhm
[CUSTOMER][NEUTRAL] We did this morning yeah.
[CUSTOMER][NEUTRAL] My I I leave it here too.
[AGENT][NEUTRAL] OK, so the in the hospital, um.
[AGENT][NEUTRAL] Inpatient benefit that is going to be $500 max per calendar year.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] You say I'm sorry, 500 or 5000?
[AGENT][NEUTRAL] Right, 500 per calendar year.
[CUSTOMER][NEUTRAL] 0 500 for inpatient per calendar year.
[AGENT][NEUTRAL] Yes.
[AGENT][NEUTRAL] Yes.
[AGENT][POSITIVE] Correct.
[CUSTOMER][NEUTRAL] So 500.
[AGENT][NEUTRAL] Yes, that's why I had to check that.
[CUSTOMER][NEUTRAL] Oh.
[CUSTOMER][NEUTRAL] Yeah, I know it's weird oh OK.
[AGENT][NEUTRAL] It's a bit different, yeah, I had to make sure that was right, so yeah, but that's what it says.
[CUSTOMER][NEUTRAL] Uh.
[CUSTOMER][POSITIVE] Oh OK, OK, good, good, no problem, thank you so much for your help. um, may I have please your name and the reference number?
[AGENT][NEUTRAL] Yeah
[AGENT][NEUTRAL] Sure, reference number would just be my first name, last initial, and today's date. Uh, so my name is spelled [PII] last [PII] And was there anything else I could help you with?
[CUSTOMER][POSITIVE] No, thank you so much and have a wonderful day.
[AGENT][POSITIVE] Alright, you're very welcome thanks for calling APL you too bye bye.
[CUSTOMER][POSITIVE] Thank you bye bye.