AccountId: 011433970860
ContactId: 50c3e693-b801-459a-9b71-441cee094931
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 449079 ms
Total Talk Time (AGENT): 196945 ms
Total Talk Time (CUSTOMER): 68122 ms
Interruptions: 0
Overall Sentiment: AGENT=1, CUSTOMER=1.8
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/01/28/50c3e693-b801-459a-9b71-441cee094931_20250128T17:27_UTC.wav
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[AGENT][NEUTRAL] Hi, thank you for calling APL. This is [PII]. How can I help you today?
[CUSTOMER][NEUTRAL] Hey [PII], my name's [PII]. I am trying to verify eligibility and benefits for an individual, please.
[AGENT][POSITIVE] OK, yeah, I'd love to help you with some eligibility and benefits today. Do you mind if I snag a quick call back number in case we get disconnected?
[CUSTOMER][NEUTRAL] Sure it's [PII].
[AGENT][POSITIVE] Wonderful. And what is the member's policy number?
[CUSTOMER][NEUTRAL] I am not 100% sure. I called the preventative side of such first and they gave the number that I had then was it started with a D and they said you would not be able to use that, but maybe you could use her name and date of birth.
[AGENT][POSITIVE] OK, I can certainly try looking her up with her first and last name. Absolutely. Give me one second.
[AGENT][NEUTRAL] And what, how do you spell her first name?
[CUSTOMER][POSITIVE] Thank you.
[CUSTOMER][NEUTRAL] It is [PII]
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] And the last name is [PII]
[AGENT][POSITIVE] Perfect.
[AGENT][NEUTRAL] And could you verify Ms. [PII]'s date of birth for me please?
[CUSTOMER][NEUTRAL] I have [PII].
[AGENT][POSITIVE] Wonderful. So this is your number and I can give you her policy number with us if you'd like it.
[CUSTOMER][NEUTRAL] Yes, please.
[AGENT][NEUTRAL] Perfect, so she has a policy number of 257-412-0.
[AGENT][NEUTRAL] And you said you're looking for eligibility and benefits today, is that correct?
[CUSTOMER][POSITIVE] Thank you.
[CUSTOMER][NEUTRAL] Correct, looks like she's coming in for a biopsy.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] 1 2nd to get all that pulled up.
[CUSTOMER][POSITIVE] Thank you.
[AGENT][NEUTRAL] She'll be outpatient with you I I assume?
[CUSTOMER][NEUTRAL] Yes ma'am.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] Alright, and actually let me pull up her policy document real quick.
[AGENT][NEUTRAL] Um,
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] Usually I can get everything I need off the snapshot of benefits but.
[AGENT][NEUTRAL] I just wanna make sure I'm giving you.
[AGENT][NEUTRAL] Everything right and I do wanna let you know while I'm waiting for that to load any benefit information I give over the phone today is it's just a verification of coverage and not a guarantee of payment.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] So her policy with us is a limited hospital indemnity policy. Um, it looks like as far as her benefits go, um, she does have an accident and sickness surgery benefit. I'm not sure if that would cover the biopsy, um.
[AGENT][NEUTRAL] But it is for um a surgery performed in a physician's office or in a
[AGENT][NEUTRAL] Let me double check, you it's a facility and a physician's office.
[AGENT][NEUTRAL] Um,
[AGENT][NEUTRAL] Yeah, in a facility, a surgical outpatient facility or in a physician's office, and she has that benefit she can use once per calendar year, um, do you know if she'll be in an outpatient facility or in a physician's office because they have different benefit amounts.
[CUSTOMER][NEUTRAL] It would be outpatient facility.
[AGENT][NEUTRAL] OK, and then outpatient facility her benefit amount is up to $500.
[AGENT][NEUTRAL] Um,
[CUSTOMER][POSITIVE] OK perfect.
[AGENT][NEUTRAL] And then I'm not showing particularly any other outpatient benefits um but she does have on here.
[AGENT][NEUTRAL] A
[AGENT][NEUTRAL] A critical illness benefit. So let me see if.
[AGENT][NEUTRAL] Mhm
[AGENT][NEUTRAL] OK, it looks like.
[AGENT][NEUTRAL] She could have coverage.
[AGENT][NEUTRAL] If she is diagnosed with.
[AGENT][NEUTRAL] A critical illness.
[AGENT][NEUTRAL] Um,
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] And so some forms of cancer may be listed underneath that.
[AGENT][NEUTRAL] Um, and I would actually, I would probably transfer you to, um, somebody that processes these to go through that just because there's some like words and definitions I don't process claims that I know and I would hate to try to interpret that.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][POSITIVE] Absolutely.
[CUSTOMER][NEUTRAL] OK
[CUSTOMER][POSITIVE] Yeah, no worries at all. Is there a reference number for what we've got so far?
[AGENT][NEUTRAL] Yes, absolutely. My name is and the, I cannot talk, ma'am. I'm so sorry. My name and today's date are the um it's [PII], first initial last name, [PII], and then today's date.
[CUSTOMER][NEUTRAL] You're fine.
[CUSTOMER][POSITIVE] Alright, thank you so much [PII]. I appreciate your help today.
[AGENT][POSITIVE] Hey, it's my pleasure. Thank you so much for calling APL and I hope you have such a fabulous day.
[CUSTOMER][POSITIVE] Thank you. You too. Bye-bye.