AccountId: 011433970860
ContactId: 52a401d1-3144-4d5e-ab12-f2b4a1c5fff0
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 431540 ms
Total Talk Time (AGENT): 212597 ms
Total Talk Time (CUSTOMER): 117625 ms
Interruptions: 4
Overall Sentiment: AGENT=1.5, CUSTOMER=1.3
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/04/24/52a401d1-3144-4d5e-ab12-f2b4a1c5fff0_20250424T15:06_UTC.wav
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[AGENT][POSITIVE] Good morning. Thank you for calling APL. This is [PII]. How can I help you?
[CUSTOMER][NEUTRAL] Hi, I was calling to verify benefits and eligibility.
[AGENT][NEUTRAL] OK, did you say that you were needing to verify eligibility and benefits?
[CUSTOMER][NEUTRAL] Uh-huh.
[AGENT][POSITIVE] Yes, ma'am, I can help you with that. And who am I speaking with?
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] Thank you and [PII], what is your callback number?
[CUSTOMER][NEUTRAL] [PII]
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] I'm so sorry. What were the last 4 numbers? There's an echo on our call, [PII]. It sounds like you're a long way from the phone.
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] OK, that was a little better. OK, what is the patient's policy number?
[CUSTOMER][NEUTRAL] It is 02609280.
[AGENT][NEUTRAL] OK, thank you one moment while I get the member's information pulled up.
[AGENT][NEUTRAL] And any information [PII] that I did provide for you today will be a verification of benefits and not a guarantee of payment. What is your pay.
[AGENT][NEUTRAL] Patient's name and their date of birth.
[CUSTOMER][NEUTRAL] It is.
[CUSTOMER][NEUTRAL] Um, I'm gonna spell the first name, [PII]
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] [PII], um date of birth [PII].
[AGENT][POSITIVE] OK, thank you.
[AGENT][NEUTRAL] OK, so I do show that he is the subscriber on this limited benefit plan and this policy is active with an effective date of [PII].
[AGENT][NEUTRAL] And what type of benefit information are you needing for him today, [PII]?
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Um, an emergency room visit.
[AGENT][NEUTRAL] Inpatient outpatient office.
[AGENT][NEUTRAL] OK. So, on this, you said, OK, emergency room visit. OK.
[CUSTOMER][NEUTRAL] Um, outpatient.
[AGENT][NEUTRAL] So on this policy, it does not cover emergency room visits.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] This limited benefit plan doesn't cover an emergency room visit.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK, that is what I need to know. um, could I get your name and a call reference number?
[AGENT][NEUTRAL] Alright.
[AGENT][NEUTRAL] Sure, again, my name is [PII], and my name along with today's date would be the call reference number.
[AGENT][NEUTRAL] And [PII], if you will end up filing a claim on this number, uh, once the claim has been processed with APL, there is a portal that we have that you should be able to check the status in as well.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] And that is located at [PII].
[CUSTOMER][NEUTRAL] OK, um, can I get the first initial of your last name, [PII]?
[AGENT][NEUTRAL] Yes, and then what is yours?
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] OK.
[AGENT][POSITIVE] All right, thank you. And is there anything else, [PII] that I could help you with today?
[CUSTOMER][POSITIVE] Thank you.
[CUSTOMER][NEUTRAL] Um, I don't believe so. Let me there, um, so I had.
[CUSTOMER][NEUTRAL] So somebody, um, one of our other, um, newer employees called and so I just wanted to verify like I was just checking behind her to verify, um, and, um, her note says that the, um, it's a limited indemnity policy but it does pay $75 towards an ER visit.
[AGENT][NEUTRAL] Uh-huh.
[AGENT][NEUTRAL] Mhm.
[AGENT][POSITIVE] That is correct.
[AGENT][NEUTRAL] That's for an office, an outpatient sickness visit.
[CUSTOMER][NEUTRAL] OK, not for ER.
[AGENT][POSITIVE] No, but I will be happy to double-check that for you. So give me just a moment.
[CUSTOMER][NEUTRAL] Yeah, no, that's OK.
[AGENT][NEUTRAL] Well, and I'm glad that I did cause I was about to give you incorrect information. So on this particular, yeah, and I did, and I would have caught it, and I would have called you back and hopefully, I could have reached you, [PII]. Um, so, yes, on this specific outpatient sickness writer that they have on this policy, that could be for an office visit with in a physician's office, urgent care facility or an ER.
[CUSTOMER][NEUTRAL] OK
[AGENT][NEUTRAL] And on this, um,
[AGENT][NEUTRAL] The benefit
[AGENT][NEUTRAL] I'm sorry, give me just one second. And I apologize about that. Most of these policies that either clearly states that or, uh, so I pulled the policy information to look at it. It is a maximum benefit $75 per visit and a max number of 5 visits per calendar year per covered person.
[CUSTOMER][POSITIVE] No, you're good.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][POSITIVE] OK perfect um well I almost no you're good.
[AGENT][POSITIVE] And again, I am sorry about giving you incorrect information initially.
[CUSTOMER][NEGATIVE] I almost didn't even call because I've seen this, um, I saw the card and I was like, oh I already know the answer to this, they don't cover, um.
[AGENT][NEUTRAL] Yeah, some do, some of these, these, right, some of it just depends. There's a lot of different types of these, um, indemnity policies. So some of them do have benefits.
[CUSTOMER][NEUTRAL] But then I saw the note and I was like, well, let me check.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][POSITIVE] I got you.
[AGENT][NEUTRAL] Some of them do not. So, you know, it's not right. Yeah, it's not just 11 size fits all on these policies. It depends on what the employer has selected.
[CUSTOMER][POSITIVE] So it is good we do probably need to keep calling every time OK alright well perfect.
[CUSTOMER][NEUTRAL] Yes, OK, well.
[CUSTOMER][POSITIVE] Yeah, well, thank you for the information, [PII].
[AGENT][POSITIVE] Well, you're welcome. Yes, ma'am. And is there anything else, [PII] I could help you with?
[CUSTOMER][POSITIVE] No ma'am, that is it thank you so much.
[AGENT][POSITIVE] Well, you're certainly welcome and thank you again for calling APL. I hope you have a great day.
[CUSTOMER][POSITIVE] Thanks you too bye.
[AGENT][POSITIVE] Yes ma'am. Thank you. Bye bye.