AccountId: 011433970860
ContactId: 7e402f17-2367-4c65-9e3d-978039830321
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 238630 ms
Total Talk Time (AGENT): 104594 ms
Total Talk Time (CUSTOMER): 68150 ms
Interruptions: 0
Overall Sentiment: AGENT=1.4, CUSTOMER=0.6
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/03/18/7e402f17-2367-4c65-9e3d-978039830321_20250318T21:30_UTC.wav
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[AGENT][NEUTRAL] Good afternoon. Thank you for calling APL. This is [PII]. How may I assist you?
[CUSTOMER][NEUTRAL] Hi, my name is [PII]. I'm calling with the provider's office. I'm calling to see if the patient is still active with you guys.
[AGENT][NEUTRAL] Sure, I can assist you with eligibility. I'm sorry, I didn't quite catch your name. Can you repeat your name?
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] [PII], OK. Thank you. And may I have a callback number just in case we get disconnected?
[CUSTOMER][NEUTRAL] Yes, it's [PII].
[AGENT][NEUTRAL] Thank you. And may I have the patient's policy number?
[CUSTOMER][NEUTRAL] 02571784
[AGENT][POSITIVE] Thank you.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] May I have the name and date of birth of the patient?
[CUSTOMER][NEUTRAL] [PII] [PII].
[AGENT][POSITIVE] OK, perfect, thank you.
[AGENT][NEUTRAL] And you say you need eligibility. We have an effective date of [PII]. It is showing active at the moment and this is a limited hospital indemnity plan.
[CUSTOMER][NEUTRAL] OK, um, so the patient did state that um it is term because she's no longer with that job. Do you know how long that takes effect for it to show on your guys' end?
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] Um, it is managed by a third party, uh, so we're not gonna know until we receive that paperwork, and we have not received anything just yet indicating it's gonna be terminated.
[CUSTOMER][NEUTRAL] OK and then um can I get the benefits for a specialist office?
[AGENT][NEUTRAL] OK, 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. Um, it looks like we cover $50 per visit, maximum of 4 visits per cover person per calendar year, and that is a flat amount.
[CUSTOMER][NEUTRAL] OK
[CUSTOMER][NEUTRAL] So $50 per visit and that's 4 visits a year?
[AGENT][POSITIVE] Correct.
[CUSTOMER][NEUTRAL] OK
[CUSTOMER][NEUTRAL] And
[CUSTOMER][NEUTRAL] Let me see, do you guys cover contraceptives of any kind?
[AGENT][NEUTRAL] No.
[AGENT][NEUTRAL] We don't.
[CUSTOMER][NEUTRAL] No, OK
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] And then what what about well woman exams, so like the pap smears?
[AGENT][NEUTRAL] OK, let me check.
[AGENT][NEGATIVE] No, this one doesn't have preventative service.
[CUSTOMER][NEUTRAL] OK, no preventative.
[CUSTOMER][NEUTRAL] And have they used any of those 4 visits for this year?
[AGENT][NEUTRAL] I can check.
[AGENT][NEUTRAL] As of today, she has not used her benefits for [PII].
[CUSTOMER][NEUTRAL] OK, and then may I just get your name and the reference number?
[AGENT][NEUTRAL] My name is [PII]
[AGENT][NEUTRAL] That's [PII], and we don't have reference numbers. You can use my name in today's name.
[CUSTOMER][NEUTRAL] OK, and then when we send out the claim, would that be to the [PII]?
[AGENT][NEUTRAL] Let me double check, hold on.
[AGENT][NEUTRAL] Yes, [PII] in [PII].
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][POSITIVE] OK perfect thank you so much.
[AGENT][POSITIVE] You're welcome. Is there anything else I can help you with today?
[CUSTOMER][POSITIVE] No, that would be it thank you.
[AGENT][POSITIVE] You're welcome and thank you for calling APL. Have a good day.
[CUSTOMER][NEUTRAL] You too bye bye.
[AGENT][POSITIVE] Thank you. Bye.