AccountId: 011433970860
ContactId: 76ef938a-2de4-4198-9508-f3fbbd66163c
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 426130 ms
Total Talk Time (AGENT): 134260 ms
Total Talk Time (CUSTOMER): 229424 ms
Interruptions: 7
Overall Sentiment: AGENT=0.6, CUSTOMER=0.1
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/05/22/76ef938a-2de4-4198-9508-f3fbbd66163c_20250522T13:07_UTC.wav
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[AGENT][NEUTRAL] Calling APL, this is [PII]. How may I assist you?
[CUSTOMER][NEUTRAL] Hi, this is [PII] calling you from doctor office. I need to check eligibility and benefits.
[AGENT][NEUTRAL] Sure, [PII], I could assist you with that. Can I have a callback number for you and that policy number?
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] Yeah. The callback number is [PII] and it's a direct line. And the policy number is 02559891.
[CUSTOMER][POSITIVE] I'm good.
[AGENT][NEUTRAL] Can you verify that patient's name and date of birth?
[CUSTOMER][NEUTRAL] Yeah. The patient's name is [PII]. Date of birth is [PII].
[AGENT][NEUTRAL] And you're calling to verify benefits and eligibility for what place of service guy?
[CUSTOMER][NEUTRAL] I'm calling from Georgia Family Care.
[AGENT][NEUTRAL] So is this inpatient, outpatient office visit? what type of service is it?
[AGENT][NEUTRAL] Place of service.
[CUSTOMER][NEUTRAL] Um, out, outpatient and office visit for PCP.
[AGENT][NEUTRAL] Office visit, so it looks like the member has office visit benefits of.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] I
[AGENT][NEUTRAL] Give me one moment, let me verify.
[AGENT][NEUTRAL] Its office visits with 5 visits per calendar year.
[CUSTOMER][NEUTRAL] Yeah
[AGENT][POSITIVE] But let me make sure I give you the correct benefit amount.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][POSITIVE] Wow.
[CUSTOMER][NEUTRAL] I they're gonna.
[CUSTOMER][NEUTRAL] No
[CUSTOMER][NEUTRAL] So it's not for me at that time.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] So it looks like she has.
[AGENT][NEUTRAL] Office visit office visit benefits of $100 per visit with 4 visits per calendar year and this is not a guarantee of benefits, just a disclaimer of the policy's coverage. In Sky, she has not utilized any of her benefits for [PII].
[CUSTOMER][NEUTRAL] I just, I just that time of the year.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Uh, can you tell me the effective date?
[AGENT][NEUTRAL] Sure.
[CUSTOMER][NEUTRAL] Mhm
[AGENT][NEUTRAL] This policy became effective [PII] and is currently active.
[AGENT][NEUTRAL] Is there anything else that I can assist you with today?
[CUSTOMER][NEUTRAL] Uh, the
[CUSTOMER][NEUTRAL] There is no termination date.
[AGENT][NEUTRAL] No. The policy is currently active.
[CUSTOMER][NEUTRAL] Uh, what's
[CUSTOMER][NEUTRAL] What's the plan name?
[AGENT][NEUTRAL] This is a hospital indemnity policy.
[CUSTOMER][NEUTRAL] I don't
[CUSTOMER][NEUTRAL] Hospital indemnity policy.
[AGENT][NEUTRAL] Yes.
[CUSTOMER][NEUTRAL] Mm.
[CUSTOMER][NEUTRAL] OK. And what's the patient's plan type? Is it HMO, EPO, PPO?
[AGENT][NEUTRAL] PPO.
[CUSTOMER][NEUTRAL] PPO and is there a co-pay?
[AGENT][NEUTRAL] No, this is the flat amount that we will pay up to $100 per visit.
[CUSTOMER][NEUTRAL] You will pay $100 per visit.
[AGENT][POSITIVE] Yes, that is correct.
[CUSTOMER][NEUTRAL] And is the provider in network?
[AGENT][NEGATIVE] There is no network.
[AGENT][NEUTRAL] The member can go wherever they desire you to go. Mhm. Correct.
[CUSTOMER][NEGATIVE] There is no network.
[CUSTOMER][NEUTRAL] OK, let me just write. You said your name was?
[AGENT][NEUTRAL] My name is [PII].
[CUSTOMER][NEUTRAL] I
[CUSTOMER][NEUTRAL] And your last name initial?
[AGENT][NEUTRAL] [PII].
[CUSTOMER][NEUTRAL] OK. Can I also have the call reference number?
[AGENT][NEUTRAL] We don't provide those. You can use my name in today's date as a reference. Would you like for me to spell my name for you again and provide you with the date of service, today's date?
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] And
[CUSTOMER][NEUTRAL] Uh, no, I got, uh, can you tell me the time it's showing in your PC right now?
[CUSTOMER][NEUTRAL] Yeah
[AGENT][NEUTRAL] It is [PII]
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] It's [PII] is that Central Standard Time? OK. So, just, uh, give me a minute. OK, let me just note this down.
[AGENT][POSITIVE] Yes, that is correct.
[CUSTOMER][NEUTRAL] And do you guys have a portal?
[CUSTOMER][NEUTRAL] I
[AGENT][NEUTRAL] Do we have a who?
[CUSTOMER][NEUTRAL] Uh, web portal to patients eligibility.
[AGENT][NEUTRAL] Um, repeat that again, sir.
[CUSTOMER][NEUTRAL] You know.
[CUSTOMER][NEUTRAL] Um, so like when I, I want to check the patient's eligibility and benefit information again for that, do you guys have a web portal?
[AGENT][NEUTRAL] Oh, the website, we do have a website.
[AGENT][NEUTRAL] We have a website.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] It's [PII].
[CUSTOMER][NEUTRAL] What is the website?
[AGENT][NEUTRAL] Well, no, it's [PII].
[CUSTOMER][NEUTRAL] Uh,
[CUSTOMER][POSITIVE] [PII].
[CUSTOMER][NEUTRAL] Oh, OK.
[CUSTOMER][NEUTRAL] And I need to have a login for that, right? Like I need to register.
[AGENT][POSITIVE] Yes, that's correct. You will have to create it, yes.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] And you said you guys will cover $100 per visit.
[AGENT][POSITIVE] That is correct.
[CUSTOMER][NEUTRAL] Uh
[CUSTOMER][NEUTRAL] And also, the patient can go to any provider.
[AGENT][NEUTRAL] Yes, because our policy is a PPO.
[CUSTOMER][NEUTRAL] Uh,
[CUSTOMER][NEUTRAL] No, I didn't.
[CUSTOMER][NEUTRAL] It doesn't have to be in-network or out, out of network.
[AGENT][NEGATIVE] There is no network.
[CUSTOMER][NEUTRAL] All right.
[CUSTOMER][NEUTRAL] Got it. Uh, well, it's also a limited access plan, right?
[AGENT][NEUTRAL] That is correct. The policy has been active since [PII] and it's currently active, Sky.
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] I
[CUSTOMER][NEUTRAL] Um, it's 10 8 2024.
[CUSTOMER][NEUTRAL] Effective date.
[AGENT][NEUTRAL] [PII].
[CUSTOMER][NEUTRAL] Right.
[CUSTOMER][NEUTRAL] OK. Well, thanks, Ayah. That will be all for today then.
[AGENT][POSITIVE] Thanks for calling APL. Have a great day, Sky. Goodbye.
[CUSTOMER][NEUTRAL] Bye-bye.