AccountId: 011433970860
ContactId: 4241875f-0134-4d02-ac3d-74b4d9d08d61
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 330250 ms
Total Talk Time (AGENT): 159838 ms
Total Talk Time (CUSTOMER): 138899 ms
Interruptions: 0
Overall Sentiment: AGENT=1.8, CUSTOMER=0.7
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/03/13/4241875f-0134-4d02-ac3d-74b4d9d08d61_20250313T14:13_UTC.wav
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[AGENT][NEUTRAL] Morning. Thank you for calling APL. This is [PII]. How can I help you?
[CUSTOMER][NEUTRAL] OK
[CUSTOMER][NEUTRAL] Um, hey, I'm calling to verify eligibility and benefits.
[AGENT][NEUTRAL] OK, you need eligibility and benefits, is that correct?
[CUSTOMER][NEUTRAL] Yes, yes.
[AGENT][POSITIVE] Yes ma'am, I can help you with those things, and who am I speaking with?
[CUSTOMER][NEUTRAL] [PII]
[AGENT][NEUTRAL] OK, [PII], thank you. And your callback number, please?
[CUSTOMER][NEUTRAL] [PII]
[AGENT][NEUTRAL] Thank you and the member's policy number please, [PII]?
[CUSTOMER][NEUTRAL] Don't
[CUSTOMER][NEUTRAL] Uh, D as in David 43732453.
[AGENT][NEUTRAL] OK, thank you, but Corin, that is not an APO policy number, that is for 90 degree benefits. Is there another number on the ID card?
[CUSTOMER][NEUTRAL] But.
[CUSTOMER][NEUTRAL] Oh, I, I'm sorry, yeah, yeah, there is um 02573925.
[CUSTOMER][NEUTRAL] Oh
[AGENT][NEUTRAL] OK, thank you one moment please while I get the member's information pulled up.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] And any information that I
[CUSTOMER][NEUTRAL] So that we would use that other medical ID we wouldn't use that for anything I guess.
[AGENT][NEUTRAL] Correct, you would use for APL you're gonna use the 2nd number you gave me.
[CUSTOMER][NEUTRAL] OK
[AGENT][NEUTRAL] And any information corn 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 their date of birth?
[CUSTOMER][NEUTRAL] It is [PII]. Date of birth is [PII].
[AGENT][POSITIVE] OK, thank you.
[CUSTOMER][NEUTRAL] It
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] So I mean I said ma'am.
[CUSTOMER][NEUTRAL] [PII], but your return there you go.
[CUSTOMER][NEUTRAL] You want a dad?
[CUSTOMER][POSITIVE] They're super good.
[CUSTOMER][NEUTRAL] I mean, yeah,
[CUSTOMER][NEUTRAL] They got creamy middle.
[AGENT][NEUTRAL] OK, so I do show she is a dependent on this policy, this limited benefit plan, and this plan is active with an effective date of [PII]. And what type of benefit information do you need for her? Again, this is a limited benefit plan. It is not made.
[CUSTOMER][NEUTRAL] Uh-huh.
[CUSTOMER][NEUTRAL] Mhm
[CUSTOMER][NEUTRAL] Right, and is it for hospital only?
[AGENT][NEUTRAL] Your medical insurance.
[CUSTOMER][NEGATIVE] I'm sorry, it, it, you totally cut out there.
[AGENT][NEUTRAL] You sent out in our office.
[CUSTOMER][NEUTRAL] I'm sorry?
[AGENT][NEUTRAL] OK. I was saying this is not a major medical insurance plan. This is a limited benefit plan. So what type of benefit information do you need, inpatient, outpatient, or office?
[CUSTOMER][NEUTRAL] OK
[CUSTOMER][NEUTRAL] Right.
[CUSTOMER][NEUTRAL] Office.
[AGENT][NEUTRAL] OK, so she has an outpatient, uh, sickness benefit on this policy. The benefit is $75 per visit with a maximum of 5 visits per calendar year per covered person.
[CUSTOMER][NEUTRAL] And it's
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] $75 flat rate for outpatient visits, 5 visits a year, and does she have visits left? Can you tell that?
[AGENT][NEUTRAL] I can check that for you, just one moment.
[CUSTOMER][NEUTRAL] Well
[CUSTOMER][NEUTRAL] Oh
[CUSTOMER][NEUTRAL] Yeah
[CUSTOMER][NEUTRAL] You
[AGENT][NEUTRAL] And as of now, she has not used any.
[CUSTOMER][POSITIVE] OK, OK, thank you very much.
[AGENT][NEUTRAL] Well, you're very welcome. And then just one more thing, once the claim has been filed and processed with APO corn, we do have a portal in which you should be able to check claim status for her, and our portal website for that is secured.
[CUSTOMER][NEUTRAL] Uh huh.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] [PII].
[CUSTOMER][NEUTRAL] Yeah
[CUSTOMER][NEUTRAL] OK yeah I see that on the um back of the card there.
[AGENT][NEUTRAL] OK. All right. Well, is there anything else that I can help you with at the moment?
[CUSTOMER][POSITIVE] No, that'll do it thank you very much.
[AGENT][POSITIVE] OK, well then thank you again for calling APL and mhm.
[CUSTOMER][POSITIVE] Oh, I, I'm sorry.
[CUSTOMER][NEUTRAL] I did have one other question. I'm sorry, um, well visits, does it cover well visits the same as it would cover a sick visit?
[AGENT][NEUTRAL] Oh.
[AGENT][NEUTRAL] No, she does have a wellness exam and or test benefit that's also it's separate. That's a $75 benefit.
[CUSTOMER][POSITIVE] The wellness is as well.
[AGENT][NEUTRAL] Yes, it's separate. It's a separate benefit from the one that I just gave you.
[CUSTOMER][NEUTRAL] OK, um.
[CUSTOMER][NEUTRAL] But it would also pay a cap of $75 for a well visit.
[AGENT][NEUTRAL] That is correct. For just uh is it a wellness exam or test benefit?
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Yeah, it's just um her [PII] well child check.
[AGENT][POSITIVE] Yes, ma'am. That would be the benefit.
[CUSTOMER][POSITIVE] OK all right thank you.
[AGENT][POSITIVE] Well, you are certainly very welcome and again, is there anything else I can help you with?
[CUSTOMER][NEUTRAL] That strategy
[CUSTOMER][POSITIVE] No, that'll do it thank you so much.
[AGENT][POSITIVE] Oh, you're welcome and thank you again for calling APL. I hope you have a great day.
[CUSTOMER][NEUTRAL] Oh
[CUSTOMER][POSITIVE] Thanks you too bye bye.
[AGENT][POSITIVE] Yes ma'am. Thank you. Bye bye.