AccountId: 011433970860
ContactId: 5d038d69-b4f9-40a9-98a9-af37cd4a940a
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 458899 ms
Total Talk Time (AGENT): 172134 ms
Total Talk Time (CUSTOMER): 143166 ms
Interruptions: 0
Overall Sentiment: AGENT=0.7, CUSTOMER=-0.1
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/06/17/5d038d69-b4f9-40a9-98a9-af37cd4a940a_20250617T17:30_UTC.wav
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[AGENT][POSITIVE] And thank you for calling American Public Life. This is [PII]. How may I help you?
[CUSTOMER][NEUTRAL] Hi [PII], my name is [PII]. I'm calling in from Pacific Medical Center, um, and so I just wanted to see, um, if I could get, um, confirmation of benefits and if I could get an ID number so I can run on my side here.
[AGENT][NEUTRAL] Yes, ma'am. May I have the patient's first and last name?
[CUSTOMER][NEUTRAL] Yeah
[CUSTOMER][NEUTRAL] Yes, ma'am. Um, the first name [PII]
[CUSTOMER][NEUTRAL] Last name, [PII]
[CUSTOMER][NEUTRAL] Date of birth?
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] And the last name was [PII]?
[CUSTOMER][NEUTRAL] [PII]
[CUSTOMER][NEUTRAL] [PII]
[AGENT][NEUTRAL] OK, and can I have a good callback number for you?
[CUSTOMER][NEUTRAL] Yes, it's [PII].
[AGENT][POSITIVE] Thank you. One moment.
[AGENT][NEUTRAL] Thank you for verifying that information. Please be advised that verification of coverage does not guarantee the payment of a claim. So the policy number will be 02640985.
[AGENT][NEUTRAL] This plan is effective [PII] and it is active.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] I
[CUSTOMER][NEUTRAL] So when you say it's uh it may not cover any claim um he has a referral for sports medicine with our offices um could you tell me the status under your, your system whether or not he can take this appointment or if he should take the appointment?
[AGENT][NEUTRAL] OK, let me get this policy pulled up. This is a hospital indemnity plan. It is a limited benefit plan. One moment.
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Yeah
[CUSTOMER][NEUTRAL] Is it
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] OK, let's see if they have.
[CUSTOMER][POSITIVE] Thank you.
[AGENT][NEUTRAL] OK, so this is one of the newer plans. This policy is not in our system. One moment.
[AGENT][NEUTRAL] See if I can get this looked up.
[CUSTOMER][NEUTRAL] Oh, OK.
[AGENT][NEUTRAL] No, and this one does not. So what I'll have to do is I'll have to get it over to that department so that they can get this policy loaded into our system and then I can verify those benefits. And it was for physical therapy?
[CUSTOMER][NEUTRAL] Uh, no, sports medicines.
[AGENT][NEUTRAL] Sports medicine.
[AGENT][NEUTRAL] Would it be in an office setting, outpatient, inpatient?
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] It's um, yeah, see, this would be outpatient.
[CUSTOMER][NEUTRAL] He's not our patient and he's see sports medicine. It's an outpatient.
[AGENT][NEUTRAL] OK. So.
[CUSTOMER][NEUTRAL] Inpatient
[AGENT][NEUTRAL] OK, so let me, OK.
[CUSTOMER][NEUTRAL] Give me 1 2nd.
[CUSTOMER][NEUTRAL] Inpatient
[CUSTOMER][NEUTRAL] Well we're not a hospital, so, so we're not a hospital. I'm sorry, I don't quite know how to answer your question we're not a hospital we're we're a clinic we're by appointment base.
[AGENT][NEUTRAL] OK. So let me
[AGENT][POSITIVE] Get this benefit interpreted and there is no co-pays on this, so it's only a benefit amount, but let me get all the facts for this and I'll give you a call back.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Sorry.
[CUSTOMER][NEUTRAL] It
[CUSTOMER][NEUTRAL] So how long do you think this will take? My doctor's asking.
[AGENT][NEUTRAL] OK, it shouldn't take long. I'm reaching out to them right now. Actually, hold on, she just responded.
[CUSTOMER][NEUTRAL] OK, and it does look like we're outpatient.
[AGENT][NEUTRAL] OK, I'm gonna place you on a brief hold. Let me see if she can interpret this one moment. Thank you.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEGATIVE] Yeah. You are on hold.
[AGENT][NEUTRAL] Hey, can you help me with this?
[AGENT][NEUTRAL] Of course, there's no policy in the system. So it's that HI, what is it? HI 17B. I do see all the
[AGENT][NEUTRAL] Benefits and all that. This lady is calling for benefits for sports medicine outpatient. Would that be covered under this policy?
[AGENT][NEUTRAL] Yes. I asked her was it physical therapy? She said no, it's sports medicine.
[AGENT][NEUTRAL] I have no idea. She said it's going to be at their facility, so it is outpatient.
[AGENT][NEUTRAL] But she said it's not physical therapy, it's sports medicine.
[CUSTOMER][NEGATIVE] You are on hold.
[AGENT][NEUTRAL] Outpatient physical therapy.
[AGENT][NEUTRAL] OK, OK.
[AGENT][NEUTRAL] Right.
[AGENT][NEUTRAL] Mhm. Yeah.
[AGENT][POSITIVE] OK, thank you, appreciate you.
[AGENT][NEUTRAL] Bye bye.
[AGENT][NEUTRAL] [PII], thanks for holding. She interpreted the policy. She indicated that unless it's physical therapy, it would not be covered under this policy.
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][POSITIVE] All right, ma'am. um, so it looks like our patient has to make a decision. Um, uh, [PII], thank you so much for your help. I appreciate you. Thank you for working so actively. Um, I appreciate all your help. I hope you have a great day, OK?
[AGENT][POSITIVE] [PII], you're so welcome. And thank you for calling American Public Life. Have a great day. Bye-bye.
[CUSTOMER][NEUTRAL] You too bye.