AccountId: 011433970860
ContactId: 7d551e9d-3027-406e-8f5f-6cd99d12de27
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 273820 ms
Total Talk Time (AGENT): 157047 ms
Total Talk Time (CUSTOMER): 109346 ms
Interruptions: 3
Overall Sentiment: AGENT=0.8, CUSTOMER=0.8
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/03/31/7d551e9d-3027-406e-8f5f-6cd99d12de27_20250331T18:20_UTC.wav
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[AGENT][NEUTRAL] Afternoon. Thank you for calling APL. This is [PII]. How may I help you today?
[CUSTOMER][NEUTRAL] Hi, I'm calling to check benefits for a patient calling from Pembroke Pink Imaging.
[AGENT][NEUTRAL] Yes, ma'am.
[AGENT][POSITIVE] OK, I'd be glad to help you. Go ahead and give me your name and the member's policy number, please, ma'am.
[CUSTOMER][NEUTRAL] My, my, my name is [PII]. The policy number I'm calling about is 18027.
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] OK, give me that policy number one more time, please, ma'am.
[CUSTOMER][NEUTRAL] 18027.
[AGENT][NEUTRAL] That's not quite enough numbers. It should be an eight digit certificate number. [PII]. Do you see anything that says that?
[CUSTOMER][NEUTRAL] Hold on.
[CUSTOMER][NEUTRAL] Give me one minute. I'm looking at her card. Give me a second.
[AGENT][NEUTRAL] Yes, ma'am.
[CUSTOMER][NEUTRAL] It says [PII] employee and spouse group number.
[CUSTOMER][NEUTRAL] OK, I think it's uh 02595817.
[CUSTOMER][NEUTRAL] M as in Mary, L as in Louis, number 8.
[AGENT][NEUTRAL] Yes, that sounds more like it. OK, [PII], thank you so much for all that information. Yes, ma'am. OK, now while I'm pulling this up, Miss. [PII], go ahead and give me a good return telephone card number, please.
[CUSTOMER][POSITIVE] That's it. Thank you. I'm sorry.
[CUSTOMER][NEUTRAL] [PII].
[AGENT][POSITIVE] Alrighty, thank you so much for all of that information. Now, what is your patient's name and date of birth today, please, ma'am?
[CUSTOMER][NEUTRAL] Her name is [PII] and date of birth [PII].
[AGENT][NEUTRAL] Alrighty, I thank you for all that information. That looks like [PII] is the insured on this medical supplemental plan, and I do show that her original effective date is [PII]. She is current and active, but I must advise that verification of coverage is not a guarantee of payment on a claim, but you did say you want benefits. Is that correct?
[CUSTOMER][NEUTRAL] Mm
[CUSTOMER][NEUTRAL] Yes, I wanna know what's her max and if she's met anything out of that.
[AGENT][NEUTRAL] All right, what exact benefit are you needing today? What is she having done, Ms. [PII]?
[CUSTOMER][NEUTRAL] And she's having done a breast ultrasound.
[AGENT][NEUTRAL] OK, where's it gonna be done at?
[CUSTOMER][NEUTRAL] At the office without an office visit charge?
[AGENT][NEUTRAL] OK, let me get that benefit pack pulled up. OK.
[AGENT][NEUTRAL] Let's see, OK, of course, what we are is just her medical supplemental plan. So the only thing that we would pick up and pay on is anything that is for sickness or injury that is applied towards her deductible, co-pay, or co-insurance at her primary insurance carrier. If it's not covered at her primary, it's not covered here.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] And her office visit benefits will be, of course, no office visit charge is covered, but anything done in the office um would have a $500 per calendar day benefit, no pre-cert.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] OK, has she met anything of the 500?
[AGENT][NEUTRAL] That's $500 per calendar day.
[CUSTOMER][NEUTRAL] Per calendar day.
[AGENT][POSITIVE] Yes, that's per day benefit.
[CUSTOMER][POSITIVE] Oh look at that per day. I got it, got it.
[AGENT][NEUTRAL] Yes, ma'am.
[CUSTOMER][NEUTRAL] Alright, so that's what, so, so she won't, so she won't be covered out of out of um outpatient benefits, right?
[AGENT][NEUTRAL] And is that all I can help you with today?
[AGENT][NEUTRAL] The outpatient benefit will be the exact same, $500 per calendar day benefit.
[CUSTOMER][NEUTRAL] Got it. OK. And then could, could you spell your name and then I'm gonna need a reference number and that's it?
[AGENT][NEUTRAL] Mhm.
[AGENT][NEUTRAL] All right, was that all I can answer for you, Ms. [PII]?
[CUSTOMER][NEUTRAL] Yes ma'am.
[AGENT][NEUTRAL] Alrighty, well, we don't give reference numbers, but you can use my name in today's date and my name is spelled [PII]
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][POSITIVE] Perfect. Thank you so much. You have a wonderful day today. OK?
[AGENT][NEUTRAL] All right. Well, yes, ma'am, Miss [PII].
[AGENT][POSITIVE] You as well, and thanks for calling APM Miss [PII]. Bye-bye.
[CUSTOMER][POSITIVE] You're Welcome, bye bye.