AccountId: 011433970860
ContactId: 71a97a73-7ad4-49f8-8715-e26721e2db30
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 395799 ms
Total Talk Time (AGENT): 158989 ms
Total Talk Time (CUSTOMER): 129250 ms
Interruptions: 1
Overall Sentiment: AGENT=0.3, CUSTOMER=0.3
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/03/20/71a97a73-7ad4-49f8-8715-e26721e2db30_20250320T16:20_UTC.wav
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[AGENT][NEUTRAL] Good morning. Thank you for calling APL. This is [PII]. How may I assist you?
[CUSTOMER][NEUTRAL] Hi, my name is [PII]. I'm calling from Columbia River Women's Center. I was hoping to verify the benefits of a member of yours.
[AGENT][POSITIVE] OK, sure, I can assist you with benefits, Missanon. May I have a callback number just in case we get disconnected?
[CUSTOMER][NEUTRAL] Of course that is gonna be [PII].
[AGENT][NEUTRAL] Thank you. And may I have the patient's policy number?
[CUSTOMER][NEUTRAL] Yes, let's see.
[CUSTOMER][NEUTRAL] So what I have is 02606894.
[AGENT][NEUTRAL] Mm
[CUSTOMER][NEUTRAL] So
[AGENT][NEUTRAL] All right. May I have the name and date of birth of the patient?
[CUSTOMER][NEUTRAL] Yes, so that's gonna be [PII], last name [PII].
[CUSTOMER][NEUTRAL] And date of birth is [PII].
[AGENT][POSITIVE] Thank you.
[AGENT][NEUTRAL] OK, you say you need benefits. Is this gonna be considered like an office visit or outpatient facility?
[CUSTOMER][NEUTRAL] Um.
[CUSTOMER][NEUTRAL] Yes, so it'd be a new patient office visit for an outpatient facility, mhm.
[AGENT][NEUTRAL] OK. All right. Go ahead.
[CUSTOMER][NEUTRAL] Um,
[CUSTOMER][NEUTRAL] And um there it would be uh with a gynecologist, so a specialist mhm mhm.
[AGENT][NEUTRAL] Mhm
[AGENT][NEUTRAL] OK, got you. All right. And before I give you any benefit information, I need to let you know that this is not a guarantee of payment, just a verification of coverage and that's just a disclaimer. And this particular policy is one of our limited hospital indemnity plan. So it is a limited plan. Uh, this one does cover office visit specialist or PCP. The benefit amount is 100 per covered person per calendar, um.
[CUSTOMER][NEUTRAL] Mhm
[AGENT][NEUTRAL] 100 per day. I'm sorry, maximum of 4 days per cover person per calendar year.
[CUSTOMER][NEUTRAL] Oh
[CUSTOMER][NEUTRAL] I'm so sorry you started breaking up a little bit there, so, um, for, for the specialist office is that, uh, what was the coverage?
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] It's gonna be $100 per day.
[AGENT][NEUTRAL] Maximum of 4 days per covered person per calendar year.
[CUSTOMER][NEUTRAL] OK, so sorry you were breaking up again, but let me confirm, so, uh, maximum of $100 coverage per day.
[AGENT][NEUTRAL] Mhm.
[AGENT][NEUTRAL] Yes, $100 per day, 4 days per year.
[CUSTOMER][NEUTRAL] Mhm
[AGENT][NEUTRAL] So it's up to 4 visits per year combined benefit.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] And then anything over that would be just out of pocket.
[AGENT][NEUTRAL] Correct, yes, because this one is a flat amount, it's an indemnity amount, it only pays $100.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] Can you still home in [PII]?
[CUSTOMER][NEUTRAL] Yes, so sorry, I'm just writing that down and then.
[AGENT][NEUTRAL] OK, no, that's fine.
[CUSTOMER][NEUTRAL] With that, does she have any copays for visits?
[AGENT][NEUTRAL] Mhm.
[AGENT][NEUTRAL] No, um, no, there's no co-payments, coinsurance or deductibles on this one because it's not a major medical. It's just a limited indemnity plan, so it just pays an indemnity amount.
[CUSTOMER][NEUTRAL] Hm.
[CUSTOMER][NEUTRAL] OK, so, and for example, um, if she were to get like an ultrasound, does she have any ultrasound benefits or is it still just the, just the $100?
[AGENT][NEUTRAL] Um, let me see what's covered under imaging or diagnostic. Um, is it for diagnostic or preventative, Ms. [PII]?
[CUSTOMER][NEUTRAL] Um.
[CUSTOMER][NEUTRAL] I believe.
[CUSTOMER][NEUTRAL] Let's see.
[CUSTOMER][NEUTRAL] I'm not, I'm not too sure.
[AGENT][NEUTRAL] Oh sure, OK, that's fine. Let me just go ahead and pull those benefits. One moment.
[CUSTOMER][NEUTRAL] Um,
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] And you did say ultrasound, correct?
[CUSTOMER][NEUTRAL] In ultrasound mhm.
[AGENT][NEUTRAL] OK. All right.
[AGENT][NEUTRAL] OK, so.
[AGENT][NEUTRAL] Yeah, it looks like it's only gonna cover that $100 for the visit. Um, the diagnostic testing is for, um, different types of diagnostic. It's not including an ultrasound.
[CUSTOMER][NEUTRAL] Alright
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK
[CUSTOMER][NEUTRAL] And just to verify, um, are we in network? Are you able to see that or it doesn't matter?
[AGENT][NEGATIVE] And there's no network. Yeah, there's no network.
[CUSTOMER][POSITIVE] OK perfect.
[CUSTOMER][NEUTRAL] Alright, and is there a reference number for today's call?
[AGENT][NEUTRAL] We don't have reference numbers. You can use my name in today's date. Do you need the spelling of my name or any other information?
[CUSTOMER][NEUTRAL] OK, uh, and so what was your name?
[AGENT][NEUTRAL] My name is [PII]. That's [PII], last initial [PII].
[CUSTOMER][POSITIVE] OK, thank you that was all the information I needed.
[AGENT][POSITIVE] All right. Well, thank you for calling APL. You have a good day, Ms. [PII].
[CUSTOMER][NEUTRAL] You as well bye bye.
[AGENT][NEUTRAL] Goodbye.