AccountId: 011433970860
ContactId: 5f58a7c7-1842-4c58-90a8-920710074bf4
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 380440 ms
Total Talk Time (AGENT): 193833 ms
Total Talk Time (CUSTOMER): 139797 ms
Interruptions: 4
Overall Sentiment: AGENT=1.6, CUSTOMER=0
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/04/29/5f58a7c7-1842-4c58-90a8-920710074bf4_20250429T17:27_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] Yes, this is [PII] with South Providence Family Medicine, and I was trying to get um verify benefits and eligibility.
[AGENT][NEUTRAL] OK, [PII], you're needing eligibility and benefit information for a member, is that correct?
[CUSTOMER][NEUTRAL] Yes ma'am.
[AGENT][POSITIVE] Yes, ma'am. I can help you with those things. And what is a good callback number for you, please?
[CUSTOMER][NEUTRAL] Um, what's my number today? [PII].
[AGENT][NEUTRAL] Thank you and the member's policy number please [PII]?
[CUSTOMER][NEUTRAL] 02300419
[AGENT][NEUTRAL] OK, thank you one moment while I get the member's information pulled up please.
[CUSTOMER][NEUTRAL] Oh OK.
[CUSTOMER][NEUTRAL] Oh.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] OK, so any information [PII] that I do provide for you 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] Yeah.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] [PII]
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Date of birth is [PII].
[AGENT][NEUTRAL] OK, thank you. So I do show that he is the subscriber on this limited benefit plan. This is a hospital indemnity limited benefit plan. And yes, ma'am, it is active with an effective date of [PII].
[CUSTOMER][NEUTRAL] Yeah
[AGENT][NEUTRAL] And what type of benefit information are you needing for him today, inpatient, outpatient or office?
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] He
[CUSTOMER][NEUTRAL] Office.
[AGENT][NEUTRAL] For an office visit?
[CUSTOMER][NEUTRAL] Yes ma'am.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] So for a physician's office visit due to outpatient accident or sickness, the benefit on this plan is $75 per day and a maximum of 6 days per calendar year per covered person.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Alright, so he has $75 coverage per day for 6 for 6 visits basically.
[AGENT][NEUTRAL] For 6 days for.
[CUSTOMER][NEUTRAL] I think it's coming in
[AGENT][NEUTRAL] Yes, it states $75 per day.
[AGENT][NEUTRAL] Maximum of 6 days per calendar year per covered person.
[AGENT][NEGATIVE] And as of now it does not show that he's used any for this calendar year.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Alright then and.
[AGENT][NEUTRAL] And if you all do end up filing a claim with us for him, [PII], once the claim has been processed, we do have a portal in which you should be able to check claim status and the website for our portal is located at secured.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] [PII]
[AGENT][NEUTRAL] [PII].
[AGENT][NEUTRAL] [PII].
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] [PII].
[CUSTOMER][NEUTRAL] Yeah
[CUSTOMER][NEUTRAL] OK, so $75 a day per day maximum of 6 days for office visits.
[AGENT][NEUTRAL] Mhm.
[AGENT][NEUTRAL] Due to accident or sickness per calendar year, yes, ma'am.
[CUSTOMER][NEUTRAL] Oh
[CUSTOMER][NEUTRAL] I
[AGENT][POSITIVE] That is correct.
[CUSTOMER][NEGATIVE] Your sickness.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] And your name?
[AGENT][NEUTRAL] My name again is [PII] and you would use my name along with today's date if you need a call reference number.
[CUSTOMER][NEUTRAL] OK, with an IE and E or just a Y?
[AGENT][NEUTRAL] None of the above, just an eye.
[CUSTOMER][NEUTRAL] How do you spell [PII]? Just an [PII]
[AGENT][POSITIVE] With correct. Mhm mhm.
[CUSTOMER][NEGATIVE] That was one I didn't get.
[AGENT][NEUTRAL] Most people don't, so it's OK, [PII]. Most don't. They'll say just like you did, everything but uh, just the eye. So it's OK. No worries.
[CUSTOMER][NEUTRAL] And
[CUSTOMER][NEUTRAL] Yeah
[AGENT][POSITIVE] No worries.
[AGENT][NEUTRAL] Most of the time, if they don't even ask me to spell it, I don't spell it because as long as they, they have [PII], that's close enough.
[CUSTOMER][NEUTRAL] Alright, and today is still.
[CUSTOMER][NEUTRAL] All right, I always ask for spelling because even they can even misspell my name and it's [PII].
[AGENT][NEUTRAL] All right.
[AGENT][NEUTRAL] Yeah, I understand. I mean, things are spelled all different ways and I'm not even a young person, so, you know.
[CUSTOMER][NEUTRAL] But
[CUSTOMER][NEUTRAL] I had somebody spell it.
[CUSTOMER][NEUTRAL] Me either, but um I had, I saw somebody, right? My name is [PII] I said no, it's [PII], not [PII].
[AGENT][POSITIVE] Wow.
[AGENT][POSITIVE] Wow. Yeah.
[CUSTOMER][NEUTRAL] And they went, well, that's how I spell [PII]. That's how so and so in my family. I said that's [PII].
[AGENT][NEUTRAL] Uh yeah, [PII] is [PII]. I've never heard that pronounced any other way, and that's actually my daughter's middle name. So I've, yeah. Uh-huh. I've never heard that pronounced another way, but hey, learn something new every day, right?
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Oh yeah, oh, I worked at a community college. You'd be you wouldn't be surprised at some of the names I had to guess how to pronounce.
[AGENT][NEUTRAL] No, I probably wouldn't be.
[AGENT][NEUTRAL] I'm sure I would not be surprised at all.
[CUSTOMER][NEUTRAL] We had one name that was so long we had to put the last name on the um underneath the first name.
[AGENT][POSITIVE] Oh, wow. Wow. I do see a few of those occasionally.
[CUSTOMER][NEUTRAL] Well, actually we put the last name on top and then the first name was on bottom so we'd be able to file it alphabetically.
[AGENT][POSITIVE] Yeah. Oh my gosh. Wow. Wow.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] Well, well, [PII].
[CUSTOMER][POSITIVE] So that you have a great day. Thank you for your help.
[AGENT][POSITIVE] I hope you do too. Yes, ma'am, you're welcome. And is there anything else I can help you with today?
[CUSTOMER][NEUTRAL] No, ma'am, that this is the only one I've had so far.
[AGENT][POSITIVE] OK. Well, thank you so much then for calling APL and I hope you have a great afternoon.
[CUSTOMER][NEUTRAL] Alright
[CUSTOMER][POSITIVE] Thank you you too.
[AGENT][POSITIVE] Thank you very much. Bye-bye.
[CUSTOMER][NEUTRAL] Bye bye.