AccountId: 011433970860
ContactId: 3777f005-bd3a-4fde-a601-59e0ca1e6476
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 240500 ms
Total Talk Time (AGENT): 119442 ms
Total Talk Time (CUSTOMER): 78016 ms
Interruptions: 0
Overall Sentiment: AGENT=0.2, CUSTOMER=0.3
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/01/14/3777f005-bd3a-4fde-a601-59e0ca1e6476_20250114T21:44_UTC.wav
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[AGENT][POSITIVE] Good afternoon. Thank you for calling APL. My name is [PII]. How may I help you?
[CUSTOMER][NEUTRAL] Hi [PII], I'm calling for um eligibility on a patient who's in our office now.
[AGENT][NEUTRAL] OK, well, I can help you with the eligibility. May I have your name and a good contact number in case we're disconnected?
[CUSTOMER][NEUTRAL] My name is [PII]. My number is [PII].
[AGENT][NEUTRAL] Thank you for that. And may I have the member's policy number?
[CUSTOMER][NEUTRAL] Um, sure.
[CUSTOMER][NEUTRAL] Oh boy, somebody's in her chart. OK, let me see if I could see it. It's 258-456-2.
[AGENT][NEUTRAL] Thank you, hold on one moment.
[AGENT][NEUTRAL] And can you verify the member's um first and last name and date of birth?
[CUSTOMER][NEUTRAL] [PII]. Date of birth is [PII].
[AGENT][NEUTRAL] Thank you for that. And all the information provided is a verification of benefits, not a guarantee of payment. Um, so I am showing that the policy is active, it's been effective since [PII].
[CUSTOMER][NEUTRAL] OK, and does she have um what is her copay for today? Does she have any?
[AGENT][NEUTRAL] Um, hold on one moment.
[AGENT][NEUTRAL] Yes, so this policy is a hospital indemnity policy, so there's no co-pay.
[AGENT][NEUTRAL] Um, let me see if there's
[CUSTOMER][NEUTRAL] What kind of policy? I'm sorry?
[AGENT][NEUTRAL] Hospital indemnity, so it's a limited medical policy. They may have primary, they may have a primary insurance, um, but with APL they just have the hospital indemnity policy, which does not have
[CUSTOMER][NEUTRAL] So this is only for hospital?
[AGENT][NEUTRAL] No, that's just the the name of the policy. There's like wellness and other benefits, but it's a hospital indemnity policy, but there's no co-pay or deductible. Um, hospital indemnity just means it's a limited medical policy. So there's a list of benefits if it
[CUSTOMER][NEUTRAL] So
[CUSTOMER][NEUTRAL] Can you tell me if she's covered for a regular office visit for today?
[AGENT][NEUTRAL] Sure, hold on one moment.
[AGENT][NEUTRAL] So I'm just waiting for the benefits to populate. Hold on one moment.
[AGENT][NEUTRAL] OK, so for um office visits, the policy will pay up to $75 with a max of 5 visits per calendar year.
[CUSTOMER][NEUTRAL] 5 visits a year. OK, so she'll have some kind of, OK, and because she's here for actually for UTI, so she's gonna have a lab bill as well. Will it cover the labs or do the labs have to go to a special lab with this plan? She doesn't have a card yet. That's why I'm otherwise I would just.
[AGENT][NEUTRAL] Um, let me see.
[AGENT][NEUTRAL] Oh, no, you're totally fine. Um, let me see what's considered with the
[AGENT][NEUTRAL] So, under diagnostic testing, the policy specifies it to MRIs.
[AGENT][NEUTRAL] CT scans and colonoscopy.
[AGENT][NEUTRAL] Um, in terms of like labs.
[CUSTOMER][NEUTRAL] No, this will just be a urinalysis, yeah.
[AGENT][NEGATIVE] Yeah, in terms of labs, there's no coverage with this policy.
[CUSTOMER][NEUTRAL] No coverage so we should send it to someone that does self pay, OK.
[CUSTOMER][NEUTRAL] All right, let me take care of that. Can I just have a reference number please?
[AGENT][NEUTRAL] Sure, so there's no call reference number, um, but you can use my name in today's date. That's [PII], first initial and my last name is [PII], and then today's date.
[CUSTOMER][POSITIVE] OK, thank you so much [PII] have a good night.
[AGENT][POSITIVE] You're very welcome. You also, thanks for calling APL.
[CUSTOMER][NEUTRAL] OK, bye.
[AGENT][NEUTRAL] Bye bye.