AccountId: 011433970860
ContactId: 4d0ad44c-292d-483a-b32b-bd6058def1c8
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 877479 ms
Total Talk Time (AGENT): 156612 ms
Total Talk Time (CUSTOMER): 180807 ms
Interruptions: 0
Overall Sentiment: AGENT=1.1, CUSTOMER=-1
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/01/13/4d0ad44c-292d-483a-b32b-bd6058def1c8_20250113T14:59_UTC.wav
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[AGENT][POSITIVE] Good morning and thank you for calling APL. This is [PII]. How can I help you?
[CUSTOMER][NEUTRAL] Hi [PII], um, good morning. This is [PII]. I'm calling for benefits. How do you spell your name?
[AGENT][NEUTRAL] [PII]
[CUSTOMER][NEUTRAL] And your last name initial?
[AGENT][NEUTRAL] [PII]
[CUSTOMER][POSITIVE] Thank you.
[AGENT][NEUTRAL] Do you have a policy number or social so I can access the account?
[CUSTOMER][NEUTRAL] Um, the member ID is 0, policy number is 02559900.
[AGENT][POSITIVE] OK, thank you, bear with me just a moment.
[AGENT][NEUTRAL] OK, can I please verify the member's full name and date of birth?
[CUSTOMER][NEUTRAL] [PII] [PII].
[AGENT][NEUTRAL] Thank you and you said you were calling from the provider's office?
[CUSTOMER][NEUTRAL] Yes.
[AGENT][NEUTRAL] OK. Sure.
[AGENT][POSITIVE] And yes, how can I help you today?
[CUSTOMER][NEUTRAL] Um, this patient is coming in for annual or well woman visit tomorrow. Is it covered by her by her plan?
[AGENT][NEUTRAL] OK. You said she's coming in for a well-woman visit?
[CUSTOMER][NEUTRAL] Yes.
[AGENT][NEUTRAL] OK, I'll take a look at that for you, um, bear with me just a moment please.
[AGENT][NEUTRAL] OK, give me just a moment. I'm gonna go ahead and pull up that policy here. Do you mind if I put you on a quick, uh, brief hold?
[CUSTOMER][NEUTRAL] OK.
[AGENT][POSITIVE] Thank you.
[CUSTOMER][NEGATIVE] You are on hold.
[CUSTOMER][NEGATIVE] You are on hold.
[CUSTOMER][NEGATIVE] You are on hold.
[CUSTOMER][NEGATIVE] You are on hold.
[CUSTOMER][NEGATIVE] You are on hold.
[AGENT][POSITIVE] OK, I'm so sorry for that hold. Are you still there, [PII]?
[CUSTOMER][NEUTRAL] Yes, I'm here.
[AGENT][NEUTRAL] Uh yes. OK, so, um, this is just a verification of benefits non-guarantee of payment. It does not look like the, um, well women visits are covered under this policy. This is a hospital indemnity policy.
[CUSTOMER][NEUTRAL] Mhm. OK. One moment. Let me take note of that. This is a hospital.
[CUSTOMER][NEUTRAL] Indemnity plan.
[AGENT][POSITIVE] Correct.
[CUSTOMER][NEUTRAL] OK. So it doesn't cover well woman visit?
[AGENT][POSITIVE] Correct.
[CUSTOMER][NEUTRAL] OK, since it's gonna be done in an office setting.
[AGENT][NEGATIVE] Um, there are no benefits for uh, a well woman visit under this policy.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] How about for office visit, sick office visit?
[AGENT][NEUTRAL] OK. So is it for a well it will be, that will be different. So is it for a wellness visit or will it be for a sickness?
[CUSTOMER][NEUTRAL] Um, no, it's.
[CUSTOMER][NEUTRAL] It's, it's gonna be like a sickness just uh in case this patient will come for consultation.
[CUSTOMER][NEUTRAL] Problem visit, sick office visit?
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] And the provider is an OBGYN?
[AGENT][NEUTRAL] OK, I can take a look at that. Bear with me just a moment.
[CUSTOMER][POSITIVE] OK, thank you.
[AGENT][NEUTRAL] OK, so not this policy is only gonna cover for outpatient surgery or a hospital confinement.
[CUSTOMER][NEUTRAL] I'm sorry, can you say that again? You were cutting it out.
[AGENT][NEUTRAL] This policy covers for an outpatient surgery and for hospital confinement.
[AGENT][NEUTRAL] And from medical imaging such as like a, a CT or an MRI.
[CUSTOMER][NEUTRAL] How about just like a normal um office visit, regular office visit?
[AGENT][NEUTRAL] No, ma'am.
[CUSTOMER][NEGATIVE] It's not covered.
[AGENT][POSITIVE] Correct.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] All right. I just need our call reference number, please.
[AGENT][NEUTRAL] And we don't have reference numbers that you're free to use my name and today's date.
[CUSTOMER][NEUTRAL] OK, and this patient only has this policy, right?
[CUSTOMER][NEUTRAL] Oh, OK. Um, I, I've also noticed a medical ID number in her card.
[CUSTOMER][NEUTRAL] I'm not sure if
[AGENT][NEUTRAL] I'm sorry?
[CUSTOMER][NEUTRAL] Are you also able to check this medical ID number? Maybe this is the reason why.
[CUSTOMER][NEGATIVE] There's no benefit. Can I give you this number?
[AGENT][NEUTRAL] You have a different policy number?
[CUSTOMER][NEUTRAL] Another
[CUSTOMER][NEUTRAL] Yes. It's, um, it says medical ID number.
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Maybe this one has a benefit for the woman visit. um Delta 435108.
[AGENT][NEUTRAL] 00, ma'am.
[AGENT][NEUTRAL] This is APL American Public Life, um, so Delta is a different company.
[AGENT][NEUTRAL] So that wouldn't be with us.
[CUSTOMER][NEUTRAL] I mean, D for Delta.
[AGENT][NEUTRAL] OK, and none of our policy numbers have letters in them. They would just be numbers.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] But the number that I gave you earlier, that's the um member ID as well?
[AGENT][POSITIVE] Correct. That, that was the correct policy number.
[CUSTOMER][NEUTRAL] OK. Because I'm also seeing a medical ID number on her card.
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Is it a different one?
[AGENT][NEUTRAL] The, the number that you gave us was her hospital and then the um policy number.
[CUSTOMER][NEUTRAL] Mhm. How about the medical ID number?
[AGENT][NEUTRAL] The only
[CUSTOMER][NEUTRAL] Who can check this um policy?
[AGENT][NEUTRAL] Um, I would just check whatever her primary care insurance is, and then, and then you can check with them as well, whatever her coverage is. Uh, we are her secondary, we're not primary, um, medical insurance.
[AGENT][NEUTRAL] This is a secondary policy.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] The, the, the policy that I gave you earlier, that's her secondary?
[AGENT][NEUTRAL] Yes, the company you called APL American Public Life, we are her secondary insurance company.
[CUSTOMER][NEUTRAL] Mm, OK. Because I'm also seeing medical ID number. Is it, uh, the same policy?
[CUSTOMER][NEUTRAL] Or the same plan that I gave you earlier or a different one? Because it's on the same card.
[AGENT][NEUTRAL] OK, the one with that starts with a D, we [PII]'t have any policy numbers that starts with letters. They're all numbers, so I will maybe check with her primary care insurance.
[AGENT][NEUTRAL] And see if that was maybe matches up with their numbers.
[AGENT][NEUTRAL] With their plan.
[CUSTOMER][POSITIVE] Mhm. OK. I'll just um talk to the um members. Thank you so much, [PII].
[AGENT][NEUTRAL] Uh, sure, I mean, was there anything else I could do to help you today?
[CUSTOMER][POSITIVE] That's all, thank you.
[AGENT][POSITIVE] OK, thanks for calling APL. You have a good day.