AccountId: 011433970860
ContactId: 6fbe2341-16e7-4d88-b677-2eab263eaf35
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 519679 ms
Total Talk Time (AGENT): 177331 ms
Total Talk Time (CUSTOMER): 114392 ms
Interruptions: 2
Overall Sentiment: AGENT=0.5, CUSTOMER=1
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/05/20/6fbe2341-16e7-4d88-b677-2eab263eaf35_20250520T21:50_UTC.wav
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[AGENT][NEUTRAL] Thank you for calling APL. This is [PII]. How can I help you?
[CUSTOMER][NEUTRAL] Yes, hello Miss [PII], my name is [PII]. I'm calling from Austin Regional Clinic for benefits and eligibility.
[AGENT][POSITIVE] Sure, I can help you with benefits and eligibility. Can I get a good callback number in case we get disconnected?
[CUSTOMER][NEUTRAL] Sure it's [PII].
[AGENT][NEUTRAL] Do you have the policy number?
[CUSTOMER][NEUTRAL] I have two different numbers he gave me, um, he said D as in David, 49700319.
[CUSTOMER][NEUTRAL] And if that's not it, give me a num another number too.
[AGENT][NEUTRAL] OK, can you repeat that number for me?
[CUSTOMER][NEUTRAL] Yes, D as in David, 49700319.
[AGENT][NEUTRAL] OK, one moment while I look that up.
[CUSTOMER][NEUTRAL] Let's see.
[CUSTOMER][NEUTRAL] He also gave me an alternate number of 02623133.
[AGENT][NEUTRAL] 026. What was the rest?
[CUSTOMER][NEUTRAL] Uh-huh, 231-33.
[CUSTOMER][NEUTRAL] And if that don't work, maybe we could try and name and date of birth.
[AGENT][NEUTRAL] OK, let me look that up real quick.
[CUSTOMER][POSITIVE] Thank you.
[AGENT][NEUTRAL] Let me try that one.
[CUSTOMER][NEUTRAL] Yes ma'am.
[AGENT][NEUTRAL] What is the patient's name and date of birth?
[CUSTOMER][NEUTRAL] [PII] [PII].
[AGENT][POSITIVE] OK, thank you so much.
[CUSTOMER][NEUTRAL] So it's the [PII].
[AGENT][NEUTRAL] That's the one I'm showing.
[AGENT][NEUTRAL] With us, the one that starts with a D, I think is another.
[CUSTOMER][POSITIVE] OK perfect thank you.
[AGENT][NEUTRAL] Is another company or is not another company but it's a different part.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK, OK.
[AGENT][NEUTRAL] OK, so you're wanting eligibility, correct?
[CUSTOMER][NEUTRAL] Yes, for medical coverage with the primary care and specialty.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] OK. I'm showing that this policy is active with an effective date of [PII].
[AGENT][POSITIVE] And let me pull up those benefits for you.
[CUSTOMER][POSITIVE] Thank you.
[AGENT][NEUTRAL] This is a hospital indemnity plan.
[AGENT][NEUTRAL] Um,
[CUSTOMER][NEUTRAL] Oh, so no, no, no regular doctor?
[AGENT][NEUTRAL] Not for this one, let me see.
[CUSTOMER][NEUTRAL] OK. Yes.
[AGENT][NEUTRAL] Yeah, I see hospital indemnity and they have a group accident policy.
[AGENT][NEUTRAL] Give me just a moment.
[CUSTOMER][NEUTRAL] Alright, with the name and date of birth, sir, he doesn't have regular office visit.
[AGENT][NEUTRAL] Um, let me pull, let me pull up this policy and see what all is covered.
[CUSTOMER][POSITIVE] Thank you.
[AGENT][NEUTRAL] Mhm.
[AGENT][NEUTRAL] And this is just a verification of benefits and not necessarily a guarantee of payment. I am showing that a physician's office uh treatment is allowed, but it would have to be due to an accident or sickness treatment.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK, let me see what he came in for. Give me one moment please.
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] All right, so it's the.
[CUSTOMER][NEUTRAL] After our visit was for.
[CUSTOMER][NEUTRAL] You read through discharge.
[CUSTOMER][NEUTRAL] I can spell it epididymitis Groth hematuria.
[CUSTOMER][NEUTRAL] Abdominal pain.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] OK, so if that is due, if that is a sickness because I don't, I don't know um how they will.
[AGENT][NEUTRAL] Um, show that as a procedure code. Um, I am showing that if that is covered as a, as a covered accident or sickness treatment, if he does get treated in the physician's office, he has up to $50 per day with a maximum of 4 days per calendar year.
[CUSTOMER][NEUTRAL] That's what it pays.
[AGENT][NEUTRAL] For the, for the physician's office visit. Um, there are other there are other benefits depending on what
[AGENT][NEUTRAL] What he was seen for. Um, there's there's a diagnostic testing benefit, if any of that happens.
[CUSTOMER][NEUTRAL] Right, so
[CUSTOMER][NEUTRAL] There were a bunch of labs.
[AGENT][NEUTRAL] OK. Yeah, this, this should cover that, um, because it is due to an accident or sickness. Um, they do have a hospital admission benefit as well of up to $500 per day with a maximum of 1 day per calendar year.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Alright, have you used any of the 4 visits this year?
[AGENT][NEUTRAL] Um,
[AGENT][NEUTRAL] Let me check that for you.
[AGENT][NEUTRAL] Let me see.
[AGENT][NEUTRAL] I'm not showing that anything has been used to date.
[CUSTOMER][POSITIVE] Perfect, what is the network that you guys use?
[AGENT][NEUTRAL] We don't go through network, so should you, um.
[AGENT][NEUTRAL] And then the claim and it gets denied the the insured can always submit the claim, but we don't have a network of providers.
[AGENT][NEUTRAL] For this policy, um, it will need to have.
[CUSTOMER][NEUTRAL] OK, do you give reference numbers at all?
[AGENT][NEUTRAL] Um, we don't have reference numbers, but you can use my name and last initial in today's date. So my name [PII], last initial [PII], and then today's date.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][POSITIVE] OK, perfect, Miss [PII], I thank you so very much for your time today.
[AGENT][POSITIVE] Great, thank you so much for calling APL Nicole, and I hope you have a great day.
[CUSTOMER][POSITIVE] You too now, take care.
[AGENT][NEUTRAL] That's.
[CUSTOMER][NEUTRAL] Right.