AccountId: 011433970860
ContactId: 7050c7fe-7298-41a1-a122-ea15d1c415b6
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 320470 ms
Total Talk Time (AGENT): 144590 ms
Total Talk Time (CUSTOMER): 160390 ms
Interruptions: 1
Overall Sentiment: AGENT=0.3, CUSTOMER=0.6
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/06/23/7050c7fe-7298-41a1-a122-ea15d1c415b6_20250623T13:32_UTC.wav
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[AGENT][NEUTRAL] Thank you for calling APL. This is [PII]. How can I help you?
[CUSTOMER][NEUTRAL] Hi, [PII]. My name is [PII] and I am calling from uh a surgeon's office in [PII]. I have a question um regarding a patient's insurance coverage.
[AGENT][NEUTRAL] OK, yeah, let's take a look. Do you have their policy number?
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] I do. I've got 02635534.
[CUSTOMER][NEUTRAL] Patient is [PII].
[AGENT][NEUTRAL] And then date of birth?
[CUSTOMER][NEUTRAL] Uh, his date of birth is, let me get back into that screen is [PII].
[AGENT][NEUTRAL] All right.
[AGENT][NEUTRAL] And all right, we're looking for medical coverage here.
[CUSTOMER][NEUTRAL] OK, on the card, I think it says it was effective [PII].
[AGENT][NEUTRAL] All right.
[AGENT][NEUTRAL] Yeah, so they do have an active medical plan. The number you gave me is their dental. Do you want the medical policy number?
[CUSTOMER][POSITIVE] Oh, yeah, if I could, that would be great.
[AGENT][NEUTRAL] All right, so that number is gonna be 02635531.
[CUSTOMER][NEGATIVE] OK, now questions about that. Are you able to answer or what would I have to call a different number? I know it asked me for medical or dental on the prompts, and I clicked medical and then it then it doesn't give me the option again. So I clicked something before and I sat on hold for probably 15-20 minutes and I thought I'm gonna call back and this time I pressed dental so just yeah so does he, how do I find out what type of benefit or coverage he has?
[AGENT][NEUTRAL] No.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] So it's a limited benefit plan. He's having a surgery.
[CUSTOMER][NEUTRAL] Well, he's not at this point. He's supposed to come into our office this afternoon. He's been having some abdominal pain, so I'm not exactly sure what the next step is going to be now is this like an employer plan or is this just something he took out?
[AGENT][NEUTRAL] Mhm.
[AGENT][NEUTRAL] Oh
[CUSTOMER][NEUTRAL] On his own I'm not familiar.
[AGENT][NEUTRAL] No, it's an employer plan it looks like. Um, it is what they call a hospital indemnity plan, so it's a limited benefit plan. Um, it just pays a set amount. So if he's coming in for like an office visit.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Yeah
[AGENT][NEUTRAL] The plan would pay $100 towards the visit, and they're permitted a total of 3 visits in a calendar year.
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] OK. Are there any co-pays or anything that he would be responsible for, or?
[AGENT][NEUTRAL] No, no, so the plan just pays that $100 towards the visit and then whatever responsibility is up to the facility or provider.
[CUSTOMER][NEUTRAL] The office visit?
[CUSTOMER][NEUTRAL] Nope, OK.
[CUSTOMER][NEUTRAL] OK. All right. And then if surgery were needed, is that a benefit on his contract or?
[AGENT][NEUTRAL] Let's see, so.
[CUSTOMER][NEUTRAL] Limited again.
[AGENT][NEUTRAL] Yeah, let me see if there's anything additional for surgery.
[AGENT][NEUTRAL] All right. Um,
[AGENT][NEUTRAL] So it does have a surgery benefit. Inpatient surgery is $2000 per day, maximum of 1 day.
[AGENT][NEUTRAL] Outpatient surgery, um, in a
[AGENT][NEUTRAL] Outpatient facility or hospital is $500 per day, maximum of 1 day.
[AGENT][NEUTRAL] And then if it's outpatient surgery in a physician's office, it shows the benefit of 125.
[AGENT][NEUTRAL] And it's also a maximum of one day.
[CUSTOMER][NEUTRAL] OK. So outpatient surgery based on that $500 that would be for everything as far as the surgeon fee, facility fee, that's all they would cover is the $500. So, gotcha.
[AGENT][NEUTRAL] Mm
[AGENT][NEUTRAL] Yeah, the only, yeah, the only thing additional it shows is a general anesthesia benefit, which is $500 per day.
[CUSTOMER][NEUTRAL] OK, and that's in or outpatient, I take it?
[AGENT][NEUTRAL] Yeah, yeah.
[CUSTOMER][NEUTRAL] Oh, OK.
[CUSTOMER][NEUTRAL] Perfect. Alright, so we should be using the number that you gave me then the [PII] number. Do, do you know, do they give him a separate card with that number as well, or?
[AGENT][NEUTRAL] Mhm.
[AGENT][POSITIVE] He should have one, yeah, he should have one.
[CUSTOMER][NEUTRAL] This one's done. OK, alright, OK, we can check with him when he comes in and then I show a group number of 70102.
[AGENT][NEUTRAL] Let me just verify that. Yes, that is correct.
[CUSTOMER][NEUTRAL] OK, great. All right, um, perfect, and I'm sorry, what did you say your first name was?
[AGENT][NEUTRAL] My name is [PII], that's [PII]
[CUSTOMER][POSITIVE] Perfect. Alright, thank you so much, [PII]. I appreciate your help.
[AGENT][POSITIVE] You're welcome. Have a good day.
[CUSTOMER][POSITIVE] You too thank you bye bye now.
[AGENT][NEUTRAL] Bye-bye.