AccountId: 011433970860
ContactId: 6f407b17-bdcd-4c32-81f3-8360a13e0693
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 274549 ms
Total Talk Time (AGENT): 145068 ms
Total Talk Time (CUSTOMER): 98621 ms
Interruptions: 0
Overall Sentiment: AGENT=1.3, CUSTOMER=0.6
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/01/06/6f407b17-bdcd-4c32-81f3-8360a13e0693_20250106T17:52_UTC.wav
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[AGENT][NEUTRAL] Hi, thank you for calling APL. This is [PII]. How can I help you today?
[CUSTOMER][NEUTRAL] Good morning. My name is [PII] calling from the, um, I'm calling for eligibility and benefits, please.
[AGENT][NEUTRAL] OK, yeah, I'd love to help you with some eligibility but if it's today. And can I have that policy number?
[CUSTOMER][NEUTRAL] OK
[CUSTOMER][NEUTRAL] OK. It is 02572218.
[AGENT][POSITIVE] Wonderful. And do you mind while I'm getting that policy pulled up for you if I can also grab a good callback number?
[CUSTOMER][NEUTRAL] OK, uh, phone number is [PII].
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] Mhm
[AGENT][POSITIVE] Wonderful. Thank you. And your patient's first and last name and date of birth, please?
[CUSTOMER][NEUTRAL] OK, I have [PII]. Date of birth is [PII].
[AGENT][POSITIVE] Wonderful. I do see her on here as current and active with an effective date of [PII] and you said you were needing benefits, is that correct?
[CUSTOMER][NEUTRAL] Well, actually, um, she's here uh to see the OB and I have a code. I'm not sure if that can help you.
[AGENT][NEUTRAL] OK, unfortunately I can't tell you if anything like I can't search individual procedure codes and let you know about coverage um we'd have to have it come in on that claim form um.
[CUSTOMER][NEUTRAL] OK
[AGENT][NEUTRAL] It looks like.
[AGENT][NEUTRAL] She does have a.
[AGENT][NEUTRAL] Outpatient accident treatment benefits. So if she's there for an accident, she has coverage, um,
[AGENT][NEUTRAL] And, or, no, that's for surgery.
[AGENT][NEUTRAL] It looks like your outpatient coverage is for accident treatment.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Um, so you don't know if a colposcopy is, um,
[CUSTOMER][NEUTRAL] Um,
[CUSTOMER][NEUTRAL] Oh, never mind. Uh, what would the um co-pay be for, uh, for office visit?
[AGENT][NEUTRAL] OK, yeah, so this plan doesn't have a copay. It's a limited hospital indemnity policy, so it's just a limited supplemental policy. Um, if she's there for an accident, she has a benefit of $50 in a physician's office. She can use up to twice a year.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK, so there's no copay?
[AGENT][NEUTRAL] No, because we're not a major medical policy. We're just a limited supplemental plan.
[CUSTOMER][NEUTRAL] For
[CUSTOMER][NEUTRAL] OK. Um, I'm sorry, I'm just a little confused. It, it only covers accident, uh, coverage?
[AGENT][NEUTRAL] Um, she has a lot, she has a lot of different benefits, um, but they are all very limited benefits. So if she were to have like surgery in a physician's office, it covers it for accidents and sickness. Um, she has some major diagnostic benefits, so like, um,
[CUSTOMER][NEUTRAL] OK
[AGENT][NEUTRAL] Diagnostic exams, it looks like she has a $100 benefit she could use once a year. Um, if she is being seen in the physician's office for outpatient, she does have for an accident treatment, she has up to $50 twice a year.
[AGENT][NEUTRAL] So
[CUSTOMER][NEUTRAL] OK, what about for sick visit with the PCP?
[AGENT][NEGATIVE] She does not have any benefits for that with this policy.
[CUSTOMER][NEUTRAL] Oh, OK then. All right then, um, can I get the, um, a reference number for this call, please? and the initial to your last name?
[AGENT][NEUTRAL] Yes.
[AGENT][NEUTRAL] You betcha. So the reference number is my name [PII], first initial last name, B like boy, and today's date. And then um I'm so sorry, I probably should have said this like earlier when I started talking about our benefits, but I do need to let you know that any benefit information we give over the phone is just a verification of coverage and not a guarantee of payment.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][POSITIVE] All right then um thank you for this information. I appreciate that.
[AGENT][POSITIVE] Yeah it's my pleasure and if there's anything else we can help you with, just give us a call.
[CUSTOMER][POSITIVE] OK thank you mm bye.
[AGENT][POSITIVE] My pleasure. Bye bye.