AccountId: 011433970860
ContactId: 4b32ce5a-989a-4dd5-b715-d0072fd92f4c
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 410609 ms
Total Talk Time (AGENT): 116007 ms
Total Talk Time (CUSTOMER): 151203 ms
Interruptions: 1
Overall Sentiment: AGENT=0.8, CUSTOMER=0.4
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/05/30/4b32ce5a-989a-4dd5-b715-d0072fd92f4c_20250530T16:05_UTC.wav
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[AGENT][NEUTRAL] Thank you for calling APL. This is [PII]. How can I help you?
[CUSTOMER][NEUTRAL] Hello [PII]. This is [PII] from the board office. I have a patient to check the eligibility. Could you please help me with that?
[AGENT][POSITIVE] I can help you with eligibility. [PII], can I give you a good callback number in case we get disconnected?
[CUSTOMER][NEUTRAL] Sure. It's [PII]. It's a direct line.
[AGENT][NEUTRAL] And what's the policy number?
[CUSTOMER][NEUTRAL] Yes, the policy number for the patient is 026-05286.
[AGENT][NEUTRAL] OK give me just a moment while I look that up.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] Can you verify the patient's name and date of birth for me, please?
[CUSTOMER][NEUTRAL] The patient's name is [PII] and its date of birth is [PII].
[AGENT][POSITIVE] OK, thank you so much.
[CUSTOMER][POSITIVE] You're welcome.
[AGENT][NEUTRAL] Right, I'm showing that this policy is active with an effective date of [PII].
[CUSTOMER][NEUTRAL] Date of [PII].
[CUSTOMER][NEUTRAL] Uh, and it's still active?
[AGENT][NEUTRAL] Yes, sir.
[CUSTOMER][NEUTRAL] OK. And is this patient have any PCP?
[AGENT][NEUTRAL] Let me check that for you.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] And you were wanting to know if they had benefits towards.
[CUSTOMER][NEUTRAL] Mm, I have multiple.
[AGENT][NEUTRAL] That or are you wanting the name of their
[CUSTOMER][NEUTRAL] Do you have the provider's name, the PCP name?
[AGENT][NEUTRAL] Oh no sir we don't have that.
[AGENT][NEUTRAL] I apologize.
[CUSTOMER][NEUTRAL] Uh, is it, uh, OK. Uh, what's the plan type of this patient?
[AGENT][NEUTRAL] Uh, this is a hospital indemnity policy.
[CUSTOMER][NEUTRAL] Hospital in
[CUSTOMER][NEUTRAL] policy. OK, that's the plan type. And uh could you please check our provider, our clinic is in-network or out of network.
[AGENT][NEUTRAL] Yes.
[AGENT][NEUTRAL] We don't participate in networks. Uh, we just pay a uh a benefit amount.
[CUSTOMER][NEUTRAL] OK, so there is no in network or out of network.
[AGENT][POSITIVE] Correct.
[CUSTOMER][NEUTRAL] OK. No, um.
[CUSTOMER][NEUTRAL] Uh, out of network, OK, no.
[CUSTOMER][NEUTRAL] That is OK. And for the office visits, does this plan have any co-pay?
[AGENT][NEUTRAL] Uh, let me check for you real quick.
[CUSTOMER][POSITIVE] Oh, thank you so much.
[AGENT][NEUTRAL] I'm not showing that they have hospital or um physician visits covered. You're talking about an office visit?
[CUSTOMER][NEUTRAL] Mm, office visits are not covered?
[AGENT][NEUTRAL] Not under this policy.
[CUSTOMER][NEUTRAL] Or not
[CUSTOMER][NEUTRAL] Hold on.
[AGENT][NEUTRAL] This is a hospital indemnity policy, so it's, it's, it has uh it has hospital benefits uh due to an accident or a sickness.
[CUSTOMER][NEUTRAL] For this policy of his.
[CUSTOMER][NEUTRAL] Mm.
[CUSTOMER][NEUTRAL] Absolutely um.
[CUSTOMER][NEUTRAL] Only accidents.
[CUSTOMER][NEUTRAL] And
[CUSTOMER][NEUTRAL] There will be only the hospital stay will be uh covered.
[CUSTOMER][NEUTRAL] Accidents and sickness and in the hospital stay.
[AGENT][NEUTRAL] Right, so they have an admission benefit. They have uh they have some surgery benefits, urgent care, um, they have a treatment in a phys in a physician's office benefit, but not just the hos not just the um office visit.
[CUSTOMER][NEUTRAL] Uh, what kind of treatment? Do you have that information?
[AGENT][NEUTRAL] Uh, just treatment due to an accident or illness.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] Not any specific treatments.
[CUSTOMER][NEUTRAL] So
[CUSTOMER][NEUTRAL] It's all.
[CUSTOMER][POSITIVE] Excellent. So this uh office visits were not covered, OK.
[AGENT][POSITIVE] Correct.
[CUSTOMER][NEGATIVE] Not covered
[CUSTOMER][NEUTRAL] And just for the confirmation and the claim mailing address is [PII].
[CUSTOMER][NEUTRAL] [PII] and the payer ID 64556.
[AGENT][NEUTRAL] Yes, [PII]. Yes, sir.
[CUSTOMER][NEUTRAL] Oh
[CUSTOMER][POSITIVE] OK. Thank you so much. And thank you. And may I have the call reference number?
[AGENT][NEUTRAL] So we don't have call reference numbers but you can use my name and last initial in today's date. So [PII] and today's date.
[CUSTOMER][NEUTRAL] Uh
[CUSTOMER][NEUTRAL] It's [PII]
[AGENT][NEUTRAL] [PII]
[CUSTOMER][NEUTRAL] [PII] OK.
[CUSTOMER][NEUTRAL] That's.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][POSITIVE] OK, [PII], thank you so much for providing me the information. Have a blessed day.
[AGENT][POSITIVE] Thank you for calling APL. Have a great day.
[CUSTOMER][NEUTRAL] Same to you. Bye.
[AGENT][NEUTRAL] Bye.