AccountId: 011433970860
ContactId: 5e29b08c-2058-4af4-94a2-006fd6a9a462
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 304709 ms
Total Talk Time (AGENT): 141004 ms
Total Talk Time (CUSTOMER): 78414 ms
Interruptions: 0
Overall Sentiment: AGENT=1.1, CUSTOMER=1.3
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/05/30/5e29b08c-2058-4af4-94a2-006fd6a9a462_20250530T14:44_UTC.wav
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[AGENT][POSITIVE] Good morning. Thank you for calling APL. This is [PII]. How can I help you?
[CUSTOMER][NEUTRAL] Hi, my name is [PII]. I'm calling with a provider's office to try to verify benefits for a patient.
[AGENT][NEUTRAL] OK [PII], do you also need eligibility or only benefit information?
[CUSTOMER][NEUTRAL] Um, I'll do the eligibility as well.
[AGENT][POSITIVE] Yes ma'am, I can help you with both and what is your callback number?
[CUSTOMER][NEUTRAL] [PII]
[AGENT][NEUTRAL] Thank you. And the member's policy number please, [PII]?
[CUSTOMER][NEUTRAL] Um
[CUSTOMER][NEUTRAL] The policy certification number is 02622535.
[AGENT][NEUTRAL] OK, thank you. One moment.
[AGENT][NEUTRAL] OK [PII], any information that is provided today will be a verification of benefits and not a guarantee of payment. What is your patient's name and their date of birth?
[CUSTOMER][NEUTRAL] It's for [PII]. Date of birth is [PII].
[AGENT][NEUTRAL] OK, thank you. So I do show that he is a subscriber on this hospital indemnity limited benefit plan.
[AGENT][NEUTRAL] And this policy is Active [PII] with an effective date of [PII].
[AGENT][NEUTRAL] And what type of benefit information do you need for him, inpatient, outpatient or office?
[CUSTOMER][NEUTRAL] It's outpatient. I need to see if he has a radiology services diagnostic imaging.
[AGENT][NEUTRAL] OK. So there are certain uh benefits for certain tests. What is the test that he's having?
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] He's having a CT, uh, maxillofacial exam.
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] I can give you the CPT code if you need it.
[AGENT][NEUTRAL] No, ma'am, I don't need that. That's OK. So, one moment.
[AGENT][NEUTRAL] Hm
[AGENT][NEUTRAL] OK, so on this limited benefit plan, that the benefits.
[AGENT][NEUTRAL] is $100 per day and a maximum of 1 day per calendar year per covered person.
[CUSTOMER][NEUTRAL] So they cover $100 a day, but only 1 a year.
[AGENT][POSITIVE] That is correct, yes, ma'am.
[CUSTOMER][NEUTRAL] OK, and can you tell me if authorization would be required?
[AGENT][NEUTRAL] No, ma'am, because this is
[CUSTOMER][NEUTRAL] Like prior authorization for this exam.
[AGENT][NEUTRAL] Yes, ma'am. No, it would not be, since this is not a major medical plan. It would not, it is not required.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK, so you do cover the CT, but at $100 a day, 1 per year.
[AGENT][NEUTRAL] That is correct. On this limited benefit plan, the benefit, a CT is on the list of covered tests, and the benefits, if approved, is $100 per day, maximum of 1 day per calendar year per covered person.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][POSITIVE] All right, I will let the patient know and have him decide. Thank you so much.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] OK, well, you're very welcome. And then, um, one last thing, if you all end up filing a claim with us for him, once the claim has been processed, [PII], we do have a portal in which you should be able to check claim status in, and the website for that portal is located at [PII].
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][POSITIVE] All right, thank you so much.
[AGENT][NEUTRAL] OK, yes ma'am. Well, is there anything else that I can help you with?
[CUSTOMER][POSITIVE] No ma'am, that was everything. I appreciate your help um oh wait, one more thing, am I able to get a call reference number?
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] You would use my name that I gave you along with today's date.
[CUSTOMER][POSITIVE] All right perfect thank you so much.
[AGENT][POSITIVE] OK, well, you're very welcome and again, thank you for calling APL Have a wonderful weekend.
[CUSTOMER][NEUTRAL] Likewise bye bye.
[AGENT][POSITIVE] Thank you. Bye bye.