AccountId: 011433970860
ContactId: 35ac59b2-99d9-4ce5-afbf-cb060ffd2b3c
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 298250 ms
Total Talk Time (AGENT): 142219 ms
Total Talk Time (CUSTOMER): 133411 ms
Interruptions: 2
Overall Sentiment: AGENT=1.2, CUSTOMER=1.2
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/01/14/35ac59b2-99d9-4ce5-afbf-cb060ffd2b3c_20250114T14:25_UTC.wav
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[AGENT][POSITIVE] Good morning. Thank you for calling APL. This is [PII]. How can I help you?
[CUSTOMER][NEUTRAL] Uh hello [PII]. Uh, good morning. Uh my name is [PII], last name initial [PII], and I'm calling you, uh, with the servicing facility, uh, regarding the one of our patients. I would need to check his eligibility and uh also to check if prior authorization is required if you could help me with that.
[AGENT][NEUTRAL] OK, and you said your name is [PII], is that correct?
[CUSTOMER][NEUTRAL] No, it's [PII]
[AGENT][NEUTRAL] Oh, [PII]. OK, thank you. I'm sorry, I misunderstood. OK, and you're needing, you're needing to check eligibility benefits and to see a prior authorization is required, is that correct?
[CUSTOMER][POSITIVE] Yes, no problem.
[CUSTOMER][POSITIVE] Yes, that's correct.
[AGENT][POSITIVE] Yes ma'am, I can help you with those things and [PII], what is your callback number?
[CUSTOMER][NEUTRAL] Uh, that's going to be [PII].
[CUSTOMER][NEUTRAL] [PII]
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] Thank you. And the member's policy number, please, [PII].
[CUSTOMER][NEUTRAL] Uh, that's going to be 02313957.
[AGENT][POSITIVE] Thank you, one moment.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] And down, any information that is provided today will be a verification of benefits and not a guarantee of payment. What is your patient's name and their date of birth?
[CUSTOMER][NEUTRAL] So
[CUSTOMER][NEUTRAL] Uh, patient's name is [PII]. Date of birth [PII].
[AGENT][POSITIVE] OK, thank you.
[CUSTOMER][NEUTRAL] You
[CUSTOMER][NEUTRAL] Well
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] I
[CUSTOMER][NEUTRAL] So
[AGENT][NEUTRAL] OK, so I do show that he is the subscriber on this policy. This is, uh, and this policy is active, effective for [PII].
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Yeah
[AGENT][NEUTRAL] This is not major medical insurance, [PII], that he has with APL. This is a hospital indemnity limited benefit plan.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK, so, uh.
[AGENT][NEUTRAL] And there is no prior authorization required with this plan.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] OK, uh thank you so much for this uh information, but, um, I just need to check if he has some, you know, any benefits for like outpatient services or you said it's, it's a limited, um, plan.
[AGENT][NEUTRAL] That is correct. This is a limited benefit plan, so are you needing inpatient, outpatient or office information?
[CUSTOMER][NEUTRAL] Well this is outpatient but it's office settings so it's going to be for office.
[AGENT][NEUTRAL] OK, so he has an outpatient benefits for a physician's office visit of $50 per day and a max of 5 days per calendar year.
[CUSTOMER][NEUTRAL] Mm
[CUSTOMER][NEUTRAL] OK. So $50. Uh, so, uh, he's covered up to $50. Is that correct?
[AGENT][NEUTRAL] Yes, ma'am.
[AGENT][NEUTRAL] For on this limited benefit plan, uh-huh, for a doctor's office for a visit, the benefit is $50 per day and a maximum of 5 days per calendar year.
[CUSTOMER][NEUTRAL] Basic
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Yeah
[CUSTOMER][NEUTRAL] Oh OK.
[CUSTOMER][NEUTRAL] OK, OK, uh thank you so much uh for providing uh this information to me, uh, [PII], is there any reference number that I can use for this call?
[AGENT][NEUTRAL] Yes, ma'am.
[AGENT][NEUTRAL] Yes, and you will actually use my name and today's date and then one additional piece of information, [PII] [PII] is that we do have a portal here at APL. So once the claim has been filed with us and processed, you can um check claim status by going to our portal at [PII].
[CUSTOMER][NEUTRAL] Yeah
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] [PII].
[CUSTOMER][POSITIVE] OK you said secure.
[AGENT][NEUTRAL] With a D on it, secured. [PII].
[CUSTOMER][NEUTRAL] Mm
[CUSTOMER][POSITIVE] OK, OK, perfect. Thank you so much, um, uh, for this information, [PII] and that would be all.
[AGENT][POSITIVE] Absolutely. You're very welcome. OK, well, if that's, yes, ma'am. Well, thank you for calling APL today, [PII], and I hope you have a nice day also.
[CUSTOMER][POSITIVE] You have a great day.
[CUSTOMER][POSITIVE] Thank you. You too. Bye-bye.
[AGENT][NEUTRAL] Yes, ma'am. Bye-bye.