AccountId: 011433970860
ContactId: 5dc080dd-9b57-4a80-8d8c-b7f55a6198ec
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 347079 ms
Total Talk Time (AGENT): 176488 ms
Total Talk Time (CUSTOMER): 72731 ms
Interruptions: 0
Overall Sentiment: AGENT=1.6, CUSTOMER=0.3
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/05/23/5dc080dd-9b57-4a80-8d8c-b7f55a6198ec_20250523T17:38_UTC.wav
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[AGENT][NEUTRAL] Good afternoon. Thank you for calling APL. This is [PII]. How can I help you?
[CUSTOMER][NEUTRAL] Hi, I'm calling for eligibility and benefits.
[AGENT][NEUTRAL] OK, you have, are you're needing eligibility and benefits for a member, is that correct?
[CUSTOMER][NEUTRAL] Yes.
[AGENT][POSITIVE] Yes, I can help you with that. And who am I speaking with, please?
[CUSTOMER][NEUTRAL] [PII]
[AGENT][NEUTRAL] [PII], is that correct?
[CUSTOMER][NEUTRAL] Mhm, yes.
[AGENT][NEUTRAL] Thank you. And [PII], what is your callback number?
[CUSTOMER][NEUTRAL] [PII]
[AGENT][NEUTRAL] Thank you and the member's policy number please, [PII].
[CUSTOMER][NEUTRAL] OK, one moment.
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] It is 02624865.
[AGENT][POSITIVE] Thank you. One moment please.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] And [PII], any information that I do provide for you today will be a verification of benefits and not a guarantee of payment. What is your patient's name, please, and their date of birth?
[CUSTOMER][NEUTRAL] First name is spelled [PII].
[CUSTOMER][NEUTRAL] [PII], last name [PII].
[CUSTOMER][NEUTRAL] Um, date of birth [PII].
[CUSTOMER][NEUTRAL] [PII].
[AGENT][POSITIVE] OK, thank you.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] OK, so I do show that he is the subscriber on this hospital indemnity limited benefit plan and it is active with an effective date of [PII].
[AGENT][NEUTRAL] And what type of benefit?
[CUSTOMER][NEUTRAL] OK, so what do you have?
[CUSTOMER][NEUTRAL] Oh, I'm sorry you can go ahead.
[AGENT][NEUTRAL] What type of benefit information are you needing? inpatient, outpatient or office?
[CUSTOMER][NEUTRAL] Um, it's mm office urgent care.
[AGENT][NEUTRAL] On this plan, he has an outpatient sickness benefit of, excuse me, and the benefit maximum is $75 per visit, maximum number of visits per calendar year of $5 per covered person.
[CUSTOMER][NEUTRAL] OK, um, let's see.
[CUSTOMER][NEUTRAL] So he does have urgent care?
[AGENT][POSITIVE] He has benefits on here for outpatient sickness.
[AGENT][NEUTRAL] It does not specify urgent care. This would be for an office visit.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] So I believe urgent care would be different, um.
[AGENT][NEUTRAL] It and I don't wanna say one way or the other because we see it all different ways. I can just tell you that the maximum benefit per visit if approved would be $75.
[CUSTOMER][NEUTRAL] One moment.
[CUSTOMER][NEUTRAL] Yeah.
[AGENT][NEUTRAL] Let me see if I can get a clear answer on that. It's gonna just be dependent upon how when the claim, let's see.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] It the urgent care.
[AGENT][NEUTRAL] Is listed as a place of service.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] That would be reviewable for this benefit.
[CUSTOMER][NEUTRAL] And you guys would only pay $75?
[AGENT][POSITIVE] That is the maximum benefit for an office visit, yes, ma'am.
[CUSTOMER][NEUTRAL] Mhm
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] Up to $75 per visit and then the maximum number of visits per calendar year again let me get back to that screen because I wanna give you the wrong 5 is number 5.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] And if you all end up filing a claim for this member with us, um, [PII], once the claim has been processed, we do have a portal that you should be able to check claim status in and that portal website is located at [PII].
[AGENT][NEUTRAL] [PII].
[CUSTOMER][NEUTRAL] OK, and do I need to, I, um.
[CUSTOMER][NEUTRAL] Give you guys my NPI to make sure you're in um.
[AGENT][NEUTRAL] Mm
[CUSTOMER][NEUTRAL] Oh, you can go ahead.
[AGENT][NEUTRAL] Now I would not be able to check network information. This is this plan participates with a multi plan, so you would have to speak to someone at multi plan to if you don't know if you all participate in their network.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][POSITIVE] OK, alrighty well thank you.
[AGENT][POSITIVE] Well, you're certainly very welcome. So is there anything else that I can help you with today?
[CUSTOMER][NEUTRAL] No, oh, just the reference number and that is all.
[AGENT][POSITIVE] You would use my name that, yes ma'am, you would use my name that I gave you along with today's date.
[CUSTOMER][NEUTRAL] And your name again?
[AGENT][NEUTRAL] [PII].
[CUSTOMER][NEUTRAL] [PII], OK.
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][POSITIVE] All right thank you.
[AGENT][POSITIVE] Alright, well, you're very welcome and thank you again for calling APL. I hope you have a great weekend.
[CUSTOMER][NEUTRAL] Mm mm
[CUSTOMER][NEUTRAL] You too bye bye.
[AGENT][POSITIVE] Thank you. Bye-bye.