AccountId: 011433970860
ContactId: 6b534bbb-e1f8-47c8-802f-7f37ee8fa293
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 341359 ms
Total Talk Time (AGENT): 153442 ms
Total Talk Time (CUSTOMER): 86339 ms
Interruptions: 0
Overall Sentiment: AGENT=0.3, CUSTOMER=1.3
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/04/10/6b534bbb-e1f8-47c8-802f-7f37ee8fa293_20250410T16:54_UTC.wav
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[AGENT][NEUTRAL] Thank you for calling APL. This is [PII]. How may I help you?
[CUSTOMER][NEUTRAL] Hi, [PII]. My name is [PII]. How are you?
[AGENT][POSITIVE] I'm doing well, [PII]. How are you doing today?
[CUSTOMER][POSITIVE] I'm doing well, thank you so much for asking [PII]. The last initial of my name is [PII] like rainbow. May I have yours?
[AGENT][POSITIVE] You're welcome.
[AGENT][NEUTRAL] It's A
[CUSTOMER][POSITIVE] OK, thank you.
[AGENT][NEUTRAL] May I please get your callback number, Ms. [PII]?
[CUSTOMER][NEUTRAL] [PII]
[AGENT][NEUTRAL] OK, and what is the name of the facility you're calling from, please?
[CUSTOMER][NEUTRAL] Well, I am calling from Vio Plus Specialty Pharmacy. Just checking to see if member has home infusion therapy benefits.
[AGENT][NEUTRAL] OK, I can check the benefits for the member for you. Can I please get your, the member's name, date of birth, and their policy number?
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] So remember first name is [PII]
[CUSTOMER][NEUTRAL] Last name is [PII].
[CUSTOMER][POSITIVE] [PII]
[CUSTOMER][NEUTRAL] Policy number 02585501.
[AGENT][NEUTRAL] OK, let me pull that patient up.
[CUSTOMER][NEUTRAL] Oh, and date of birth is, OK.
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Um, date of birth is [PII].
[AGENT][NEUTRAL] OK, let me see if I can find that patient real quick.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] OK, I do show that [PII] does have an active policy. Her effective date of the policy is [PII].
[AGENT][NEUTRAL] And you're looking for home infusion, so let me pull up her policy certificate.
[AGENT][NEUTRAL] And see if she has any kind of benefits like that.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] It's gonna be just a second while the computer pulls it in for us.
[AGENT][NEUTRAL] All right.
[AGENT][NEUTRAL] I am.
[AGENT][NEGATIVE] Not seeing anything in the policy that specifically states home infusion.
[AGENT][NEUTRAL] So the only thing that we can do at that point is just uh send in the claim and let the claim examiners process it.
[AGENT][NEUTRAL] Um, based on the procedure codes and diagnosis codes that come in on the claim.
[CUSTOMER][NEUTRAL] Hm.
[CUSTOMER][NEUTRAL] Um, could you go over the eligibility and plan details? What type of plan does this member have?
[AGENT][NEUTRAL] Uh, this is a hospital indemnity plan. The plan is a limited benefit plan and this is just a verified benefits. It's not a guarantee of payment. They have a hospital confinement benefit.
[AGENT][NEUTRAL] Uh, they also have a confinement rider for days in the hospital.
[AGENT][NEUTRAL] So like the first time that they ever go into the hospital, they get paid $2500.
[AGENT][NEUTRAL] And then the hospital daily confinement benefit is 200.
[AGENT][NEUTRAL] They have an intensive care coronary care writer, outpatient sickness benefit rider that pays $75.
[AGENT][NEUTRAL] A wellness and diagnostic writer that pays $25 and a surgery and anesthesia writer that pays uh
[AGENT][NEUTRAL] $100.
[AGENT][NEUTRAL] And that's basically the policy.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK, so this is not like a major medical benefit plan, right?
[AGENT][NEUTRAL] No. No, ma'am.
[CUSTOMER][NEUTRAL] No.
[AGENT][NEGATIVE] No, it is not.
[CUSTOMER][NEUTRAL] OK, well, yeah, I don't believe we could.
[CUSTOMER][POSITIVE] Proceed with these benefits. I appreciate your help, Miss [PII]. Do you have a reference number?
[AGENT][NEUTRAL] Well, you're
[AGENT][NEUTRAL] Yes, you can use my name, [PII], and today's date.
[CUSTOMER][NEUTRAL] OK dokey.
[CUSTOMER][POSITIVE] You have a wonderful day. Thank you.
[AGENT][POSITIVE] You too, [PII] thank you very much for calling APL and I hope you have an awesome day also.