AccountId: 011433970860
ContactId: 7a0eb8fb-59cf-4144-afdf-cdbbd5fcb695
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 393679 ms
Total Talk Time (AGENT): 212447 ms
Total Talk Time (CUSTOMER): 95078 ms
Interruptions: 0
Overall Sentiment: AGENT=0.2, CUSTOMER=0.2
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/01/13/7a0eb8fb-59cf-4144-afdf-cdbbd5fcb695_20250113T19:13_UTC.wav
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[AGENT][NEUTRAL] Thank you for calling APL. This is [PII] speaking. How can I help you?
[CUSTOMER][NEUTRAL] Hi, good morning, my name is [PII]. um, I'm calling for eligibility and benefits for an outpatient surgery.
[AGENT][POSITIVE] Sure [PII], I can help you with eligibility and benefits. Can I please have a callback number in case we get disconnected and I can call you back please.
[CUSTOMER][NEUTRAL] Um, yes, area code [PII].
[AGENT][NEUTRAL] Thank you and may I have the name of the provider or facility you're calling from, please?
[CUSTOMER][NEUTRAL] Selina Valley Health Orthopedics from [PII] Tardu.
[AGENT][NEUTRAL] Thank you and do you have the policy number or member ID please?
[CUSTOMER][NEUTRAL] Yes it is.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] D as in David 46401459
[AGENT][NEUTRAL] OK, thank you. Is that the only policy number you see do you have the ID card?
[CUSTOMER][NEUTRAL] Um, I see an AEDI payer ID, a group number.
[CUSTOMER][NEUTRAL] But yeah, and then the employee ID, the one I provided you.
[AGENT][NEUTRAL] OK, and do you have a social security number or we can search my name if not?
[CUSTOMER][NEUTRAL] By name I do not have a social.
[AGENT][NEUTRAL] OK.
[AGENT][NEGATIVE] I can't search with that uh.
[CUSTOMER][NEUTRAL] ID number.
[AGENT][NEUTRAL] Yeah, just bear with me for one moment.
[AGENT][NEUTRAL] What's the patient's last name?
[CUSTOMER][NEUTRAL] Um, [PII]
[AGENT][NEUTRAL] And their first name?
[CUSTOMER][NEUTRAL] [PII]
[AGENT][NEUTRAL] And what's the date of birth?
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] OK, thank you, just give me one moment to search please.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] [PII] OK.
[AGENT][NEUTRAL] And what um mailing address do you have for Ms. [PII] please?
[CUSTOMER][NEUTRAL] What mailing address I have for her? Let me go on her chart one second.
[CUSTOMER][NEUTRAL] Um, [PII].
[CUSTOMER][NEUTRAL] Uh yeah, we have [PII].
[AGENT][NEUTRAL] OK, and city and state please.
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] OK, thank you. I believe I have located her policy just bear with me while I pull up the policy information just to let you know it is a verification of coverage only and not a guarantee of payment.
[AGENT][NEUTRAL] Um, I do show the policy is active. The effective date for [PII] would be [PII].
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] And it is currently active.
[AGENT][NEUTRAL] And you said it was gonna be outpatient surgery, is that correct?
[CUSTOMER][NEUTRAL] Yes, done at a hospital billing for professionals.
[AGENT][NEUTRAL] OK, so this policy, uh, Joe is a limited medical hospital indemnity plan, so it does have limited medical benefits. It is not a major medical policy, um, so for that facility it will be done in a facility or physician's office hospital you said?
[CUSTOMER][NEUTRAL] Yeah, facility, yeah, hospital.
[AGENT][NEUTRAL] OK, so that facility benefit for um this plan is a $500 benefit and again that is 11 day per person per calendar year is allowed and it's a $500 benefit for facility uh surgery.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] Um, and that would be either it just depends on which claim comes to us first, so that could be either professional fee or the facility fee, uh, based on, uh, you know, when the claim is received, so there is, like I said, a $500 benefit and now again because this is limited medical, um, there is no, uh, network, there is no adjustment made to that, um, the benefit is a straight benefit payment of $500.
[AGENT][NEUTRAL] Um, do you know
[CUSTOMER][NEUTRAL] OK, so you just have to pay $500?
[AGENT][NEUTRAL] No, that's what we will pay it's $500.
[CUSTOMER][NEUTRAL] Oh
[AGENT][NEUTRAL] Again, it's not a major medical plan, so it is limited benefits.
[AGENT][NEUTRAL] Um, do you know if you participate with multi plan?
[CUSTOMER][NEUTRAL] Yes.
[AGENT][NEUTRAL] OK, so, uh, we do have multi plan, uh, I believe it's included on their ID cards, and they're encouraged to use multi plan providers that perhaps would offer them a greater savings for, um, being, uh, that this policy is not again major medical insurance.
[CUSTOMER][NEUTRAL] OK, um.
[AGENT][NEUTRAL] Did you have any other questions?
[CUSTOMER][NEUTRAL] So if we are contracted, so if we are contracted with because we are contracted with the multi plan, so then what does that?
[AGENT][NEUTRAL] Um, well, that would be up to whatever agreement you have with multi plan between your facility. Like I said, they're encouraged to use multi plan providers, but there is no, uh, network with this plan because again it is limited hospital indemnity insurance, so it doesn't meet that, uh, major medical, it's not a comprehensive, uh.
[CUSTOMER][NEUTRAL] OK
[AGENT][NEUTRAL] It's not comprehensive coverage, it is just limited medical benefits.
[CUSTOMER][NEUTRAL] OK, got you. Alright, sounds good then. Um, can I just have your first name, first letter to your last name, and a reference number for our call?
[AGENT][NEUTRAL] Certainly, so the reference number, uh, [PII] is my name and today's date. My first name [PII], last initial [PII] like love, and then today's date.
[CUSTOMER][NEUTRAL] OK 1 1325.
[CUSTOMER][POSITIVE] OK, thank you so much you have a good day.
[AGENT][POSITIVE] You too, [PII], thank you for calling AP. I hope you have a great rest of your day thank you bye bye.
[CUSTOMER][NEUTRAL] Right.