AccountId: 011433970860
ContactId: 364ef9e2-0425-4857-868a-df659693e8b1
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 729349 ms
Total Talk Time (AGENT): 306014 ms
Total Talk Time (CUSTOMER): 180460 ms
Interruptions: 3
Overall Sentiment: AGENT=0.4, CUSTOMER=0.4
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/03/05/364ef9e2-0425-4857-868a-df659693e8b1_20250305T19:38_UTC.wav
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[AGENT][NEUTRAL] Good afternoon. Thank you for calling APL. This is [PII]. How can I help you?
[CUSTOMER][NEUTRAL] Hi [PII], I was calling to verify eligibility and benefits for our patient.
[AGENT][NEUTRAL] OK, you need eligibility and benefit information, is that correct?
[CUSTOMER][NEUTRAL] Yes, ma'am.
[AGENT][POSITIVE] Yes, ma'am. I can help you with those things. And who am I speaking with, please?
[CUSTOMER][NEUTRAL] My name is [PII].
[AGENT][POSITIVE] Thank you. And [PII], what is a good callback number for you?
[CUSTOMER][NEUTRAL] It's [PII].
[AGENT][NEUTRAL] Thank you and the member's policy number please, [PII]?
[CUSTOMER][NEUTRAL] D as in Delta 459-06907
[AGENT][NEUTRAL] OK, thank you, but [PII], that is not the policy number for APL. That is a 90 degree benefit number. Does the member also have a policy with APL?
[CUSTOMER][NEUTRAL] It says that they do American Public Life.
[AGENT][NEUTRAL] OK, there should be a policy certificate number on there, not the member ID.
[CUSTOMER][NEUTRAL] Yeah, that's all they sent me to verify. Can I give you the patient's name and date of birth?
[AGENT][NEUTRAL] I can't search my date of birth. I can try by the name, um, unless it's a really common name and then that may be.
[AGENT][NEUTRAL] An issue, but what is the last name?
[CUSTOMER][NEUTRAL] Uh, [PII]
[AGENT][NEUTRAL] And the first name?
[CUSTOMER][NEUTRAL] It's [PII], so, I mean [PII]
[AGENT][NEUTRAL] OK, thank you. One moment, please.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] Is this for medical that you're needing information on?
[CUSTOMER][NEUTRAL] Yes.
[AGENT][NEUTRAL] OK, so I have located a policy and the policy number that you should have is 257.
[AGENT][NEUTRAL] 1694. I do show that she is a subscriber on this limited benefit plan with an effective date of [PII].
[AGENT][NEUTRAL] And what type of benefit information do you need for [PII] inpatient, outpatient or office?
[CUSTOMER][NEUTRAL] Um, so this is the limited benefit plan you said?
[AGENT][NEUTRAL] That is correct. It is not major medical insurance.
[CUSTOMER][NEUTRAL] OK. Um, I'm gonna need the, I mean, it's a limited benefit plan. I'm gonna need, um, specialist office visit.
[AGENT][NEUTRAL] Mhm.
[AGENT][NEUTRAL] I just, let me get the uh information pulled up please.
[AGENT][NEUTRAL] OK, so on this limited benefit plan sheet for outpatient accident and sickness treatment for a physician's office, the benefit is $100 per day and a maximum of 4 days per calendar year per covered person.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] And then, um, can I get X-ray, CT MRI?
[CUSTOMER][NEUTRAL] We'll start there and then we'll just kind of go down the list here for the limited benefits.
[AGENT][NEUTRAL] OK, so give me just one moment.
[CUSTOMER][NEUTRAL] Do you know what network this is?
[AGENT][NEUTRAL] This is part of multi plan?
[CUSTOMER][NEUTRAL] OK
[AGENT][NEUTRAL] OK, so under the diagnostic testing benefit.
[AGENT][NEUTRAL] Um, let's.
[AGENT][NEUTRAL] OK, so an X-ray, you said a plain x-ray?
[CUSTOMER][NEUTRAL] Mhm
[CUSTOMER][NEUTRAL] Yeah, X-ray.
[AGENT][NEGATIVE] And that is not covered under this plan.
[AGENT][NEUTRAL] Under the diagnostic testing benefit, the cover test or MRIs, CTs, CAT scans, RAIUs, and PET scans.
[CUSTOMER][NEUTRAL] Yeah
[CUSTOMER][NEUTRAL] OK. Um, what is the CT and the MRI scan cover?
[AGENT][NEUTRAL] And
[AGENT][NEUTRAL] OK, on this, the diagnostic benefit would be.
[AGENT][NEUTRAL] $200 per day and a maximum of 1 day per calendar year.
[CUSTOMER][NEUTRAL] OK, that's for both CT and MRI?
[AGENT][NEUTRAL] Correct, it's $200 per day and it's a max of 1 day per calendar year.
[CUSTOMER][NEUTRAL] So there'll be one for CT and one, so one for CT and then one for MRI or one combined, there's only one.
[AGENT][NEUTRAL] For one of those tests. No.
[AGENT][NEUTRAL] No, that is, it is 11 day. Mhm. The max benefit is $200.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK. And then therapy benefits, so PT, OT ATC Hydraworks.
[AGENT][NEUTRAL] Uh, that is not covered. Uh, let's see. I'm sorry. Hold on one second. Give me whoops, 1 2nd.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] OK, give me the therapy types again, [PII].
[CUSTOMER][NEUTRAL] Um, PT.
[CUSTOMER][NEUTRAL] OT ATC and Hydraworks.
[AGENT][NEUTRAL] Mhm.
[AGENT][NEUTRAL] OK, so on this benefit plan, you have the benefit for speech. OK, the benefits include physical, speech, or occupational therapy facility. That benefit is $60 per day, maximum of 4 days per calendar year per covered person.
[CUSTOMER][NEUTRAL] You said $60 per day.
[AGENT][NEUTRAL] Mhm. And yes, and a maximum of 4 days per calendar year.
[CUSTOMER][NEUTRAL] And that's just for physical therapy and occupational therapy, right?
[AGENT][NEUTRAL] Physical speech or occupational therapy.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] C T O T N S T.
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] And then are there DME benefits of Delta, Mary Echo?
[AGENT][NEGATIVE] There are not.
[CUSTOMER][NEUTRAL] And then outpatient surgery facility and outpatient surgeon benefits.
[AGENT][NEUTRAL] That is $1000 per day, maximum of 1 day per calendar year per covered person.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] And that goes for both outpatient surgeon benefits too?
[AGENT][POSITIVE] Correct.
[CUSTOMER][NEUTRAL] So, what about surgery? Is there like any, any surgery cover coverage?
[CUSTOMER][NEUTRAL] For outpatient surgery surgery?
[AGENT][NEUTRAL] Well, that would be, that is part of all of that benefit.
[CUSTOMER][POSITIVE] Got you.
[CUSTOMER][NEUTRAL] OK. Um, hospital miscellaneous?
[AGENT][NEUTRAL] What do you mean by miscellaneous? She does have.
[AGENT][NEUTRAL] Hospital admission benefits for an inpatient admission upgraded than 18 hours.
[CUSTOMER][NEUTRAL] OK, if it's not on, if it'll say hospital miscellaneous, I'm assuming I have no idea. They just give me a template and I just go down the line.
[AGENT][NEUTRAL] Uh, OK. OK, so I'm not right. I'm, I'm not sure what exactly that means.
[CUSTOMER][MIXED] You're OK. It's totally fine. I'll just put no benefits. Um, OK, and then [PII].
[AGENT][NEUTRAL] Um,
[AGENT][NEGATIVE] It does not show benefits for that.
[CUSTOMER][NEUTRAL] All righty. And then, um,
[CUSTOMER][NEUTRAL] Can a chiropractor order X-rays if it is within the scope of their license?
[AGENT][NEUTRAL] Now, for a chiropractor visit, that would also fall under that physician's office benefit.
[AGENT][NEUTRAL] Or treatment
[CUSTOMER][NEUTRAL] Oh, so [PII] falls under the position often visit.
[AGENT][NEUTRAL] So, I mean, it would be correct. Again, this would, for any out, for the outpatient accident and sickness treatment benefit, the treatment would be reviewed under that same $100 per day max of 4 days per calendar year.
[AGENT][NEUTRAL] As what an office visit, whether it's
[AGENT][NEUTRAL] A visit or treatment.
[CUSTOMER][NEUTRAL] Got you. And then um how many offices do they have remaining?
[AGENT][NEUTRAL] As of now, she has not used any.
[CUSTOMER][NEUTRAL] And then the policy runs through what dates?
[AGENT][NEUTRAL] This is a calendar year policy.
[CUSTOMER][NEUTRAL] OK, so it would be like 11 to 12:[PII]?
[AGENT][POSITIVE] Correct.
[CUSTOMER][POSITIVE] Got you.
[CUSTOMER][NEUTRAL] Alrighty, can I get a call reference number?
[AGENT][NEUTRAL] Yes ma'am, you would use my name along with today's date and then once if you all do file a claim, [PII] with [PII] on this policy, once the claim has been processed, you all should be able to check claim status in our portal by going to [PII].
[CUSTOMER][NEUTRAL] OK. [PII], is your name [PII]?
[AGENT][NEUTRAL] Yeah. No, neither. [PII]
[CUSTOMER][NEUTRAL] Oh, got me.
[AGENT][NEUTRAL] That's OK.
[AGENT][NEUTRAL] No, nobody ever, you know, so I'm, that's perfectly fine.
[CUSTOMER][NEUTRAL] I know, girl, I feel you, my name is [PII], but everyone always gets it wrong.
[AGENT][NEUTRAL] And I get that people hear [PII] when I say [PII]. I have a lot of people that think my name is [PII], so I'm, I'm kinda used to being called [PII].
[CUSTOMER][POSITIVE] Well, Ms. [PII], you have a wonderful day. Thank you so much for your help.
[AGENT][POSITIVE] Well, well, you're certainly very welcome if that's all then that I can help you with, [PII]. Thank you so much for calling APL and I hope you have a great afternoon as well.
[CUSTOMER][POSITIVE] Thank you.
[AGENT][POSITIVE] Yes, ma'am. You're welcome.
[CUSTOMER][NEUTRAL] Uh huh bye bye.
[AGENT][NEUTRAL] Bye-bye.