AccountId: 011433970860
ContactId: 5c450c0d-2748-4c22-9eb4-b51dbd569fd1
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 413679 ms
Total Talk Time (AGENT): 211050 ms
Total Talk Time (CUSTOMER): 103745 ms
Interruptions: 0
Overall Sentiment: AGENT=0.3, CUSTOMER=1.1
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/04/14/5c450c0d-2748-4c22-9eb4-b51dbd569fd1_20250414T17:29_UTC.wav
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[AGENT][POSITIVE] Good afternoon. Thank you for calling APL. My name is [PII]. How may I help you?
[CUSTOMER][NEUTRAL] Hi, my name is [PII]. I was calling from a Bear Holy Family Hospital in [PII]. I, I was calling about one of your members who was seen in our ER on Friday and then has also a radiology appointment coming up on the [PII].
[AGENT][NEUTRAL] OK, you're wanting to go over eligibility and benefits or?
[CUSTOMER][POSITIVE] Correct, yes.
[AGENT][NEUTRAL] OK. Well, I can help you with both the eligibility and benefits and [PII], may I have a good contact number in case we're disconnected?
[CUSTOMER][NEUTRAL] Yep it is [PII], no extension.
[AGENT][NEUTRAL] Thank you for that. And may I have the member's policy number?
[CUSTOMER][NEUTRAL] The member's policy number is D462-05637.
[AGENT][NEUTRAL] Thank you for that. Do you have a copy of the member's ID card available?
[CUSTOMER][NEUTRAL] I do.
[AGENT][NEUTRAL] On the card, do you see anywhere that says in hospital or outpatient policy cert number?
[CUSTOMER][NEUTRAL] Let me see.
[CUSTOMER][NEUTRAL] Medical coverage division. Let me see coverage is subject to plan.
[CUSTOMER][NEUTRAL] No, I don't.
[AGENT][NEUTRAL] OK, um, do you have the member's full social?
[CUSTOMER][NEUTRAL] We don't uh we don't have it in our system. I only have his date of birth, address, phone, and a copy of his, uh, Dor Doty card.
[AGENT][NEUTRAL] OK, what's the member's
[CUSTOMER][NEUTRAL] And I called them and they gave me your number.
[AGENT][NEUTRAL] OK, what's the member's first and last name?
[CUSTOMER][NEUTRAL] First name is [PII], middle name [PII], last name [PII].
[AGENT][NEUTRAL] [PII].
[AGENT][NEUTRAL] Or [PII]
[CUSTOMER][NEUTRAL] No, [PII].
[CUSTOMER][NEUTRAL] No, [PII]
[AGENT][NEUTRAL] OK, hold on one second.
[CUSTOMER][POSITIVE] No worries.
[AGENT][NEUTRAL] Ms. [PII].
[AGENT][NEUTRAL] OK, this is for their medical. Hold on one second.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] I believe I just located this coming up now.
[CUSTOMER][POSITIVE] OK, thank you.
[AGENT][NEUTRAL] You're welcome. And can you confirm his date of birth for me, please?
[CUSTOMER][NEUTRAL] His date of birth is [PII].
[AGENT][NEUTRAL] Here we go. Thank you and all the information provided is a verification of benefits, not a guarantee of payment. So I am showing the policy is active. It's been effective since [PII]. And um let me see, his benefits are coming up now.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] OK
[AGENT][NEUTRAL] OK, so this is a hospital indemnity policy. So it's a limited medical benefit policy. So he does have a, you know what, let me pull up the big one. Hold on one moment, OK, so I can give details. Hold on one second. Thank you.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][POSITIVE] No worries, you're fine.
[CUSTOMER][NEGATIVE] You are on hold.
[AGENT][NEGATIVE] Cause that don't really help.
[AGENT][NEUTRAL] I do what I don't.
[AGENT][NEUTRAL] He has imaging, 2 images a year up to 100.
[AGENT][NEUTRAL] That has the test, it'll pay $100.02 times for calendar year. If there's a follow, it will pay $25 once. The thing is,
[AGENT][NEUTRAL] That's probably the
[AGENT][NEUTRAL] The diagnostic testing and radiology is two different things.
[AGENT][NEUTRAL] For sure, yeah, does this policy specify?
[AGENT][NEUTRAL] OK
[AGENT][NEUTRAL] Yeah.
[AGENT][NEUTRAL] Mhm.
[AGENT][NEUTRAL] So she's
[AGENT][NEUTRAL] Emergency room on Friday. He had radiology on the [PII]. If he wasn't admitted, he can't use any of that.
[CUSTOMER][NEGATIVE] You are on hold.
[AGENT][NEUTRAL] And
[AGENT][NEUTRAL] This is only OK.
[AGENT][NEUTRAL] Hello [PII].
[CUSTOMER][NEUTRAL] Uh huh.
[AGENT][NEUTRAL] All right, thank you so much for holding. I apologize for that wait. OK, so for the emergency room, he was he ever admitted or just the ED visit?
[CUSTOMER][POSITIVE] No, no problem.
[CUSTOMER][NEUTRAL] No, he was not admitted. Yeah, he was discharged that same night.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] So the reason I'm asking is because the policy only covers hospital admission and confinement.
[AGENT][NEUTRAL] A um surgery in relation to an accident or sickness and then diagnostic testing, which I was hoping the radiology um would go under there, it, but it specifies the types of tests. What, um, well, did you want me to tell you what it covers or you want me to tell you what, or you want to tell me what he's having?
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] He's OK, he's having, let me see, it's a radiology appointment for abdominal pain. Let me see, hold on real quick.
[CUSTOMER][NEUTRAL] A CT from for his abdomen, pelvis with ID.
[AGENT][NEUTRAL] OK, good. OK, so under the medical imaging, CT is one of them.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] The policy would pay up to $100 twice per calendar year. Did you want me to see if he's used any of those already?
[CUSTOMER][POSITIVE] OK perfect.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][POSITIVE] Yes please.
[AGENT][NEUTRAL] OK, hold on one second.
[AGENT][NEUTRAL] OK, and so far for [PII], he hasn't used any of the diagnostic testing, so he still has those two tests. So it's $100 per day with a max of 2 days per calendar year, and if a follow-up test or advanced study is needed, the policy will pay $25 per day with a max of 1 day per calendar year.
[CUSTOMER][POSITIVE] OK perfect.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][POSITIVE] OK alright perfect that's all I needed to know I appreciate your help.
[AGENT][POSITIVE] You're very welcome. Well, thank you for calling APL. I hope you have a great week.
[CUSTOMER][POSITIVE] You have a great day you too bye.
[AGENT][POSITIVE] Thank you. Bye-bye.