AccountId: 011433970860
ContactId: 68a2c75d-ff23-431d-b6a1-27f08af5daad
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 320549 ms
Total Talk Time (AGENT): 109282 ms
Total Talk Time (CUSTOMER): 121125 ms
Interruptions: 1
Overall Sentiment: AGENT=2, CUSTOMER=0.5
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/02/26/68a2c75d-ff23-431d-b6a1-27f08af5daad_20250226T13:45_UTC.wav
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[AGENT][POSITIVE] Good morning. Thank you for calling APL. My name is [PII]. How may I help you?
[CUSTOMER][NEUTRAL] Um, hi [PII], I was calling to verify coverage on a patient that's being seen in the office today.
[AGENT][POSITIVE] OK, well, I'll be more than happy to assist you with the eligibility. May I have your name and a good contact number in case we're disconnected?
[CUSTOMER][NEUTRAL] Sure, my name is [PII]. It's [PII]
[AGENT][NEUTRAL] Thank you for that. And may I have um a good contact number in case we're disconnected and then the policy number?
[CUSTOMER][NEUTRAL] Sure, the contact number is [PII].
[CUSTOMER][NEUTRAL] And [PII], what's your first initial of your last name please?
[AGENT][NEUTRAL] Um, [PII].
[CUSTOMER][POSITIVE] Thank you and um.
[AGENT][POSITIVE] You're welcome.
[CUSTOMER][NEUTRAL] Members's ID is [PII] as [PII] 43730867.
[AGENT][NEUTRAL] OK, do you have a copy of the member's ID card available?
[CUSTOMER][NEUTRAL] Yes ma'am.
[AGENT][NEUTRAL] On the card, do you see anywhere that says inhospital or outpatient policy um certification number?
[CUSTOMER][NEUTRAL] Um, no, ma'am.
[CUSTOMER][NEUTRAL] It gives coverage individual. There's a policy cert number, an effective date and then it says plan limited benefit hospital in indemnity.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] Yes.
[AGENT][NEUTRAL] The policy um cert number.
[CUSTOMER][NEUTRAL] OK, it's 02491802.
[AGENT][NEUTRAL] Thank you. Hold on one moment. So that number there is the um APL policy number. The D number is for 90 degree benefits.
[CUSTOMER][POSITIVE] OK thank you um my apologies.
[AGENT][NEUTRAL] You're welcome. Oh no, you're fine.
[AGENT][NEUTRAL] And then um can you verify the member's first and last name and date of birth?
[CUSTOMER][NEUTRAL] Um, yes, first name [PII], last name [PII]. Date of birth is [PII].
[CUSTOMER][NEUTRAL] And I think that might be so you're saying for his insurance ID number we should be using the policy, sir.
[AGENT][NEUTRAL] Mhm.
[AGENT][NEUTRAL] Well, for APL.
[CUSTOMER][NEUTRAL] Number
[AGENT][NEUTRAL] For APL, yes, but um, yeah, for the other parts of his, his other insurances, right.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] The D number, OK, OK.
[AGENT][NEUTRAL] And all the information provided is a verification of benefits, not a guarantee of payment. And um how may I assist you today?
[CUSTOMER][NEUTRAL] I'm just calling like it says we have to contact the payer in order to um verify coverage. He's being seen by a um gastroenterologist today.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] So it's a specialist office visit?
[CUSTOMER][NEUTRAL] Yes ma'am.
[AGENT][NEUTRAL] OK, hold on one moment.
[AGENT][NEUTRAL] And do you mind if I place you on just a brief hold? I'm just going through the benefits.
[CUSTOMER][NEUTRAL] Sure.
[AGENT][NEUTRAL] OK, hold on one moment.
[CUSTOMER][NEGATIVE] You are on hold.
[CUSTOMER][NEGATIVE] You are on hold.
[AGENT][NEUTRAL] Hello [PII].
[CUSTOMER][NEUTRAL] Yes.
[AGENT][POSITIVE] Thank you so much for holding. I apologize for that wait. So, for the specialist office, um, the policy will pay up to $75 per visit with a max of 5 visits per calendar year.
[CUSTOMER][POSITIVE] No worries.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] But he does have coverage.
[AGENT][NEUTRAL] Right, so a hospital indemnity policy is a limited medical um policy. So,
[AGENT][NEUTRAL] For the specialist office, physician office, any office, um, that would be the, the benefit up to $75.05 times a year.
[CUSTOMER][NEUTRAL] Which means he will get right that means he'll get uh he may receive a bill, but as far as verification of coverage, he does have this policy and there is a portion that an office visit does cover.
[AGENT][NEUTRAL] Mhm.
[AGENT][POSITIVE] Correct.
[CUSTOMER][POSITIVE] OK, that's what I needed to know. Thank you.
[AGENT][POSITIVE] You're welcome. Well, was there anything else I can help with today?
[CUSTOMER][POSITIVE] Um, no, ma'am, thank you so much.
[AGENT][POSITIVE] You're welcome. Well, thanks for calling APL. I hope you have a great day.
[CUSTOMER][NEUTRAL] You too bye bye.
[AGENT][POSITIVE] Thank you. Bye-bye.