AccountId: 011433970860
ContactId: 5748f0ba-524a-4b84-8fb8-9797f6af4871
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 267679 ms
Total Talk Time (AGENT): 94997 ms
Total Talk Time (CUSTOMER): 120695 ms
Interruptions: 3
Overall Sentiment: AGENT=1.7, CUSTOMER=0.1
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/01/10/5748f0ba-524a-4b84-8fb8-9797f6af4871_20250110T18:47_UTC.wav
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[AGENT][NEUTRAL] [PII], this is [PII]. How may I help you?
[CUSTOMER][NEUTRAL] Like for us.
[CUSTOMER][NEUTRAL] Yes, um, my name is [PII] calling from Greenville Pediatric Services. I'm just trying to get benefits and eligibility for a patient.
[AGENT][NEUTRAL] OK, [PII], I can help you with benefits and eligibility. In any case this call is disconnected, may I have your callback number?
[CUSTOMER][NEUTRAL] Uh
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] [PII]
[AGENT][NEUTRAL] Thank you. May I have the patient's policy number?
[CUSTOMER][NEUTRAL] Um, yes, it's gonna be.
[CUSTOMER][NEUTRAL] 02580464
[AGENT][NEUTRAL] Thank you, and it was 0258064?
[CUSTOMER][NEUTRAL] Um, 02580464.
[AGENT][POSITIVE] Thank you.
[AGENT][NEUTRAL] And may I have the patient's name and date of birth?
[CUSTOMER][NEUTRAL] [PII].
[CUSTOMER][NEUTRAL] Um, [PII].
[AGENT][POSITIVE] Thank you.
[CUSTOMER][NEUTRAL] Mhm
[AGENT][NEUTRAL] OK, I show this is a limited hospital indemnity plan, so it covers limited benefits. I do show it's currently active, effective [PII].
[CUSTOMER][NEUTRAL] And I will, uh
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] Yeah.
[AGENT][NEUTRAL] This plan covers hospitalization for being confined. This is for um inpatient and it also covers outpatient sickness. It pays a limited benefit for an office visit um for due to sickness or emergency room or urgent care.
[CUSTOMER][NEUTRAL] See, we, uh, I'm not first.
[CUSTOMER][NEUTRAL] OK, yeah, we're um we're in office.
[CUSTOMER][NEUTRAL] Um, office setting and we're, we're a primary care provider and they're being seen today for a sick appointment.
[AGENT][NEUTRAL] OK, so the plan does, does have an outpatient sick benefit. It pays a limited benefit of $75 per visit and there's a max of 5 visits per calendar year. And I just must advise that this is just a verification of coverage and benefits. It does not guarantee payment.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Um, so you said it pays $75 per visit?
[AGENT][POSITIVE] Correct.
[CUSTOMER][NEUTRAL] For up to 5 visits per calendar year.
[AGENT][NEUTRAL] Yes.
[CUSTOMER][NEUTRAL] OK, and that's, is that just for the office, is it?
[AGENT][NEUTRAL] Yes, that's for the uh services in the physician's office.
[CUSTOMER][NEUTRAL] OK. What if they get any labs done? Would, would that pay or?
[AGENT][NEUTRAL] Um, any labs performed in a physician's office and billed by the physician's office that will fall under the same benefit.
[CUSTOMER][NEUTRAL] So
[CUSTOMER][NEUTRAL] OK, so it's gonna pay 75 up to $75 for that as well, or I mean, I'm confused. So
[AGENT][NEUTRAL] Max per visit. That's the max payable for the visit.
[AGENT][NEUTRAL] Whether it's labs or just a physician office fee, the max is only 75 for per visit.
[CUSTOMER][NEUTRAL] Oh, so, OK, so 70, OK.
[CUSTOMER][NEUTRAL] And you guys use the multi-plan network.
[AGENT][NEUTRAL] Yes.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] So if whatever is over $75 would be patient responsibility.
[AGENT][NEUTRAL] Yes.
[CUSTOMER][NEUTRAL] Is that correct? OK, got you.
[CUSTOMER][NEUTRAL] And um and so and we send claims what stands it looks like we're sending claims to IMA what does that stand for?
[CUSTOMER][NEUTRAL] What is
[AGENT][NEUTRAL] There's no, it's just IMA.
[CUSTOMER][NEUTRAL] It says attention uh.
[CUSTOMER][NEUTRAL] OK, and is it the [PII]?
[AGENT][NEUTRAL] Yes, [PII].
[CUSTOMER][NEUTRAL] Is that [PII]?
[CUSTOMER][NEUTRAL] OK, and the payer ID is 64556.
[AGENT][POSITIVE] Yes, that is correct.
[CUSTOMER][NEUTRAL] OK, OK.
[CUSTOMER][POSITIVE] All right, well, I think we've got it. Well, thank you very much.
[AGENT][POSITIVE] You're welcome. Well thank you for calling APO. You have a good day.
[CUSTOMER][NEUTRAL] You too, bye bye.
[AGENT][POSITIVE] Thanks bye.