AccountId: 011433970860
ContactId: 5b304ae7-8280-493f-8ebf-c7c68a141c62
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 343260 ms
Total Talk Time (AGENT): 89815 ms
Total Talk Time (CUSTOMER): 86399 ms
Interruptions: 0
Overall Sentiment: AGENT=1.2, CUSTOMER=0.8
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/04/28/5b304ae7-8280-493f-8ebf-c7c68a141c62_20250428T15:14_UTC.wav
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[AGENT][NEUTRAL] Thank you for calling APL. This is [PII]. How may I help you?
[CUSTOMER][NEUTRAL] Hi, good morning. I'm calling from, um, facility. I'm calling for eligibility for one of your members.
[AGENT][NEUTRAL] Of course, I can help you with eligibility today. Do you have the policy number?
[CUSTOMER][NEUTRAL] It's um 02584926.
[AGENT][POSITIVE] OK, perfect. Thank you.
[AGENT][NEUTRAL] And then can I have your name and a good callback number?
[CUSTOMER][NEUTRAL] [PII] and [PII].
[AGENT][NEUTRAL] OK, [PII], what is the patient's first and last name and date of birth, please?
[CUSTOMER][NEUTRAL] It's [PII].
[CUSTOMER][NEUTRAL] Um last name [PII] Date of birth [PII].
[AGENT][NEUTRAL] Mhm.
[AGENT][POSITIVE] OK, perfect.
[AGENT][NEUTRAL] OK, so the policy is currently active. The effective date is [PII].
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] I'm just looking to see if we are in network with this plan, and I see on the card that she provided says limited benefits.
[CUSTOMER][NEUTRAL] Could you um give me a little bit more information on the benefits?
[AGENT][NEUTRAL] Yes, of course. So this is a hospital indemnity plan.
[AGENT][NEUTRAL] So we are a secondary insurance company to their primary insurance.
[AGENT][NEUTRAL] So that's why it says a limited plan.
[CUSTOMER][NEUTRAL] So it was only gonna cover hospital care, is that what?
[CUSTOMER][NEUTRAL] Oh hold on.
[AGENT][NEUTRAL] So it only pays for accident or sickness. Let me see about her policy. Sometimes they only cover accidents, sometimes only sickness.
[AGENT][NEUTRAL] OK, so it looks like this one is for accident and sickness.
[AGENT][NEUTRAL] Is this for an office visit?
[CUSTOMER][NEUTRAL] OK, so it wouldn't cover, yeah, that's what I was gonna ask. It's preventive. She's coming in as a new patient.
[CUSTOMER][NEUTRAL] So
[AGENT][POSITIVE] OK, let me look deeper into her benefits so I can let you know.
[CUSTOMER][POSITIVE] OK, thank you.
[AGENT][NEUTRAL] OK. May I ask what she's coming in for?
[CUSTOMER][NEUTRAL] Let me see what they scheduled her.
[CUSTOMER][NEUTRAL] Internal medicine, so it's just as a primary care physician, like regular office visit.
[CUSTOMER][NEUTRAL] But if she they put her in as a new patient, I'm assuming they're gonna do preventive um.
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] I
[AGENT][NEUTRAL] OK, so per her policy.
[AGENT][NEUTRAL] It looks like hospital, unless it's a hospital or an accident or a surgery, it is not covered.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] All right then I'll reach out to the patient.
[CUSTOMER][NEUTRAL] Could you provide me a reference number if you can, please?
[AGENT][NEUTRAL] Yeah, of course.
[AGENT][NEUTRAL] Yes, so it's my first name, [PII], last initial [PII], and then it would be today's date.
[CUSTOMER][POSITIVE] All right, thank you so much. I appreciate it.
[AGENT][POSITIVE] Yeah, of course. Yeah, is there anything else I can help you with while I have you on the line?
[CUSTOMER][POSITIVE] Um, no, that was it. Thank you.
[AGENT][POSITIVE] OK, yes, of course. Thanks for calling APL. Have a good day.
[CUSTOMER][NEUTRAL] OK, OK.
[CUSTOMER][NEUTRAL] Oh you too bye bye.
[AGENT][NEUTRAL] All right.