AccountId: 011433970860
ContactId: 78da04af-024d-4692-9439-9a3f05825afc
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 258798 ms
Total Talk Time (AGENT): 132680 ms
Total Talk Time (CUSTOMER): 61570 ms
Interruptions: 0
Overall Sentiment: AGENT=1.3, CUSTOMER=0.5
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/04/15/78da04af-024d-4692-9439-9a3f05825afc_20250415T19:25_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]. I need to check on benefits for this patient, please.
[AGENT][POSITIVE] OK, yeah, I can check those benefits for you. uh, [PII], can I get a good call back number from you first in case we're disconnected?
[CUSTOMER][NEUTRAL] Yes ma'am, callback number will be [PII].
[AGENT][NEUTRAL] Thank you. And then do you have that policy number?
[CUSTOMER][NEUTRAL] I do, um, I have ID number 02604421.
[AGENT][NEUTRAL] OK, and then what was the date, uh, excuse me, the name and date of birth of the member, please?
[CUSTOMER][NEUTRAL] It's [PII] [PII].
[AGENT][NEUTRAL] Perfect, thank you for verifying that, [PII]. Uh, so this policy is active. Effective date was [PII], and this is a second, or excuse me, uh, this is a limited indemnity medical plan, so it, uh, pays a set dollar amount per covered procedure and or office visit. Uh, it's not affiliated with any sort of network, um, no co-pays, no deductibles, and no authorization is required.
[CUSTOMER][NEGATIVE] So no network, no copay, no deductible?
[AGENT][NEUTRAL] Right, and no authorization is required, you would just send the claim information directly to us.
[CUSTOMER][NEUTRAL] So do we collect anything from the patient?
[AGENT][NEUTRAL] Um, um, what do you mean? For like a co-pay or anything?
[CUSTOMER][NEUTRAL] So
[CUSTOMER][NEUTRAL] Yeah, for a specialist office visit.
[AGENT][NEGATIVE] No, that this plan doesn't.
[AGENT][NEUTRAL] Uh, now let me see if that's going to be covered. Give me just a moment. These, these policies can be a little bit, um, particular. Bear with me just a moment.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Yeah, OK.
[AGENT][NEUTRAL] OK. Um, now, was this visit in regards to a, um, an accident or a sickness or an injury or anything like that?
[CUSTOMER][NEUTRAL] So this patient um looks like she's coming in for a kidney infection.
[AGENT][NEUTRAL] OK, I certainly believe that would be considered a sickness. So, um, and of course I will let you know uh verification of coverage is not a guaranteed payment for claims. Uh, so they do have an accident and sickness, uh, benefit, um, in office treatment is $75 that's the benefit amount is $75 maximum per day.
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] So that's what you guys would pay and then the rest is the is the patient?
[AGENT][POSITIVE] Correct.
[AGENT][NEUTRAL] We don't say what is patient responsibility, that would be up to the provider, but that is the maximum amount this policy could pay.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] For visit and does she have any like.
[CUSTOMER][NEUTRAL] Number of visit allowed?
[AGENT][NEUTRAL] Yes, uh, it is a maximum of, let's see, 6 days per calendar year per covered person. Uh, let me see if any of that has been used.
[CUSTOMER][NEUTRAL] So she can only have 6 visits per calendar year.
[AGENT][POSITIVE] Correct.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] OK, so none has been used uh so far this year.
[CUSTOMER][NEUTRAL] Alright, um, I think that's all I needed. Can I get a reference number for this call?
[AGENT][NEUTRAL] Sure, reference number would just be my first name, last initial, and today's date. Uh so my name is spelled [PII] Was there anything else I could help you with, [PII]?
[CUSTOMER][POSITIVE] No ma'am, that is it. Thank you so much for your help.
[AGENT][POSITIVE] Of course, thanks for calling APL. I hope you have a great rest of your day.
[CUSTOMER][POSITIVE] Uh huh you're welcome bye bye.
[AGENT][POSITIVE] Thank you. Bye-bye.