AccountId: 011433970860
ContactId: 81dcd53b-c614-41d7-9e50-764f89ca817b
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 389559 ms
Total Talk Time (AGENT): 159285 ms
Total Talk Time (CUSTOMER): 140542 ms
Interruptions: 0
Overall Sentiment: AGENT=0.9, CUSTOMER=0.3
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2024/12/31/81dcd53b-c614-41d7-9e50-764f89ca817b_20241231T15:07_UTC.wav
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[AGENT][POSITIVE] Good morning. Thank you for calling APL. This is [PII]. How can I help you?
[CUSTOMER][NEUTRAL] Hi [PII], my name is [PII]. I'm calling from the provider office and want to know about the eligibility of the member.
[AGENT][NEUTRAL] OK, [PII], you're only needing eligibility and not benefit information, is that correct?
[CUSTOMER][POSITIVE] Uh, benefit as well.
[AGENT][POSITIVE] Yes, I can help you with these things, [PII]. And what is your callback number?
[CUSTOMER][NEUTRAL] Yeah
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] Thank you and the member's policy number, please?
[CUSTOMER][POSITIVE] They make it
[CUSTOMER][NEUTRAL] OK, the member policy starts A as in Alpha, F as in Frank, D as in Doctor.
[CUSTOMER][NEUTRAL] 100
[CUSTOMER][NEUTRAL] 010377207.
[AGENT][NEUTRAL] OK, now, [PII], that is not a policy number for our company. What company were you trying to reach?
[CUSTOMER][NEUTRAL] APL just give me a second. I have a card as well.
[CUSTOMER][NEUTRAL] Uh, just give me a second.
[CUSTOMER][NEUTRAL] But
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK, uh, I have a card of the member. There's a policy certificate number and there's a medical ID, so which one do you need?
[AGENT][NEUTRAL] Policy certificate.
[CUSTOMER][NEUTRAL] OK, 02537820.
[AGENT][POSITIVE] Thank you, one moment please.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] And any information that I provide for you today will be a verification of benefits and not a guarantee of payment. What is your patient's name and date of birth?
[CUSTOMER][NEUTRAL] I
[CUSTOMER][NEUTRAL] You
[CUSTOMER][NEUTRAL] OK, is [PII] and uh the date of birth is.
[CUSTOMER][NEUTRAL] Give me a sec.
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] OK, I don't have a date of birth of the member because uh.
[AGENT][NEUTRAL] I will need the date of birth.
[CUSTOMER][NEUTRAL] It's our
[CUSTOMER][NEUTRAL] OK, so actually I have uh information of their spouse.
[AGENT][NEUTRAL] Who is the patient?
[CUSTOMER][NEUTRAL] The patient is [PII].
[AGENT][NEUTRAL] What is the date of birth of the patient?
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] Thank you. So I do show that she is the spouse of the subscriber on this limited benefit plan and this plan is active with an effective date of [PII]. Again, this is not major medical insurance. This is a hospital indemnity limited benefit plan. What type of information are you needing for or?
[AGENT][NEUTRAL] Inpatient, outpatient, or office?
[CUSTOMER][NEUTRAL] OK, first of all, the plan type of the, yeah, uh, the plan type of the member.
[AGENT][NEUTRAL] It is a hospital indemnity limited benefit plan.
[CUSTOMER][NEUTRAL] OK, so.
[CUSTOMER][NEUTRAL] So the members benefits cover out of network services for the professional and the facility one.
[AGENT][NEUTRAL] OK. Say that again.
[CUSTOMER][NEUTRAL] Actually we are out of network from all the peers, so does the members' benefits cover profession services and the facility services?
[AGENT][NEUTRAL] Is this for inpatient, outpatient, or office?
[CUSTOMER][NEUTRAL] OK, uh,
[CUSTOMER][NEUTRAL] Inpatient.
[AGENT][NEUTRAL] There's a hospital confinement benefit, which is $50 per day.
[CUSTOMER][NEUTRAL] OK, so is it possible you just uh send me a fax of the benefits?
[AGENT][NEUTRAL] No, sir. I'm not able to do that.
[CUSTOMER][NEUTRAL] OK, so what, uh, what is the patient responsibility? Is it copay or a cos insurance?
[AGENT][NEUTRAL] We do not determine patient responsibility. We are not a major medical insurance carrier. This, any patient responsibility would be up to the provider.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] So but you said.
[CUSTOMER][NEUTRAL] $50?
[AGENT][NEUTRAL] That
[AGENT][NEUTRAL] Correct, with a maximum benefit of 180 days for any one period of confinement.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] And this must be for a minimum of at least 24 hours.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] 2
[CUSTOMER][NEUTRAL] OK, so.
[CUSTOMER][NEUTRAL] Do thispaer have reimbursement rates?
[AGENT][NEUTRAL] Again, that is the benefit for a hospital confinement under this limited benefit plan.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK, your name again please?
[AGENT][NEUTRAL] It's [PII], and you would use my name along with today's date if you need a call reference number.
[CUSTOMER][NEUTRAL] So that.
[AGENT][NEUTRAL] And then also once the claim has been submitted and processed with APL Nick, we do have a portal which you can create a username and a password to have access to the explanation of benefits.
[CUSTOMER][NEUTRAL] Yes.
[AGENT][NEUTRAL] And that website for our portal is secured. [PII].
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] Yes, sir. Mhm.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] And is there anything else, [PII], I can help you with today?
[CUSTOMER][POSITIVE] No, no, thank you so much for that.
[AGENT][POSITIVE] Well, you are very welcome and thank you again for calling APL. I hope you have a really wonderful day and a happy New Year.
[CUSTOMER][NEUTRAL] You too. Bye-bye.
[AGENT][POSITIVE] Thank you. Bye bye.