AccountId: 011433970860
ContactId: 84058fb7-485b-4344-9736-faa4e55df7d6
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 354029 ms
Total Talk Time (AGENT): 133111 ms
Total Talk Time (CUSTOMER): 101028 ms
Interruptions: 0
Overall Sentiment: AGENT=1, CUSTOMER=1.1
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/01/21/84058fb7-485b-4344-9736-faa4e55df7d6_20250121T13:36_UTC.wav
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[AGENT][POSITIVE] Good morning. Thank you for calling APL. My name is [PII]. How may I help you?
[CUSTOMER][NEUTRAL] Hi [PII], this is [PII] calling from DMA provider's office.
[AGENT][NEUTRAL] And how are you doing today?
[CUSTOMER][POSITIVE] I'm good and thank you for asking and how about you?
[AGENT][POSITIVE] I'm doing well and from my notes, can you spell your first name for me and provide a good contact number?
[CUSTOMER][NEUTRAL] Sure, it's [PII] and my first insured, the last name is [PII].
[AGENT][NEUTRAL] OK, may I have a good contact number in case we're disconnected?
[CUSTOMER][NEUTRAL] It's [PII]
[CUSTOMER][NEUTRAL] [PII]
[CUSTOMER][NEUTRAL] [PII] and it's a direct line.
[AGENT][NEUTRAL] OK. And may I have the member's policy number?
[CUSTOMER][NEUTRAL] Yeah, let me provide you with the policy number. Just a second. Let me check with that my system is loading.
[AGENT][NEUTRAL] OK.
[CUSTOMER][POSITIVE] Thank you so much.
[AGENT][POSITIVE] You're welcome.
[CUSTOMER][NEUTRAL] And how was your day today?
[AGENT][POSITIVE] Oh, my day is going well. How's yours?
[CUSTOMER][POSITIVE] That's great and good to hear.
[AGENT][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] Hm
[CUSTOMER][NEUTRAL] And the member's policy number which is um
[CUSTOMER][NEUTRAL] Uh it's 02311714.
[AGENT][NEUTRAL] OK, hold on one moment.
[CUSTOMER][NEUTRAL] Yeah, take your time once you're ready with this information, do let me know.
[AGENT][NEUTRAL] And can you verify the member's first and last name and date of birth?
[CUSTOMER][NEUTRAL] Sure, I'll spell out the name which is [PII] and the last name is [PII]
[CUSTOMER][NEUTRAL] Sorry, [PII] and my date of birth is [PII].
[AGENT][POSITIVE] Thank you for that and all the information provided is a verification of benefits, not a guarantee of payment. And how may I help you today?
[CUSTOMER][NEUTRAL] Uh, I need to know the benefits and eligibility for the member and I have a code. I need to check the code required authorization or not. Can you please help me with that?
[AGENT][NEUTRAL] OK. Hold on one moment. So you said you needed benefits and eligibility and you need to check a code?
[CUSTOMER][NEUTRAL] Yes, for the authorization too.
[AGENT][NEUTRAL] OK. So, um, this APL doesn't require prior authorization for any of our policies because we're not a major medical.
[AGENT][NEUTRAL] And this policy has been active since [PII].
[CUSTOMER][NEUTRAL] And can I have the group number for billing purpose?
[AGENT][NEUTRAL] Sure, hold on one moment. The group number is 70056.
[CUSTOMER][NEUTRAL] Yeah
[CUSTOMER][NEUTRAL] I'm sorry about that. Can you repeat once again slowly to 7.
[AGENT][NEUTRAL] 700.
[AGENT][NEUTRAL] 56.
[CUSTOMER][NEUTRAL] It's 700.
[AGENT][NEUTRAL] 700.
[AGENT][NEUTRAL] 56.
[CUSTOMER][NEUTRAL] That's it.
[AGENT][NEUTRAL] Yes, that's the group number.
[CUSTOMER][POSITIVE] OK, thank you so much and can I have the plan type of the member?
[AGENT][NEUTRAL] This is a hospital indemnity policy. It's a limited benefit policy.
[CUSTOMER][NEUTRAL] whether it is a HMO or PPO like that.
[AGENT][NEUTRAL] That is a major insurance. This is not major insurance. The plan type is hospital indemnity.
[AGENT][NEUTRAL] And it is a limited medical benefit policy.
[CUSTOMER][NEUTRAL] Uh, can you please spell out the spelling for the uh uh plan type?
[AGENT][NEUTRAL] Hospital, HOS.
[AGENT][NEUTRAL] I
[CUSTOMER][NEUTRAL] Hospital.
[AGENT][NEUTRAL] Yes.
[CUSTOMER][NEUTRAL] And then
[AGENT][NEUTRAL] Indemnity, I like ice.
[AGENT][NEUTRAL] N like Nancy, D like dog, E like elephant.
[AGENT][NEUTRAL] M like Mary,
[AGENT][NEUTRAL] N like Nancy.
[AGENT][POSITIVE] I like ice.
[AGENT][NEUTRAL] T like Tom, Y like yellow.
[CUSTOMER][NEUTRAL] Hospital intermediate policy, right?
[AGENT][POSITIVE] Correct.
[CUSTOMER][NEUTRAL] And uh will you cover DME coverage?
[AGENT][NEUTRAL] So hold on one moment so I can take a look at the benefits.
[CUSTOMER][NEUTRAL] Yeah.
[AGENT][NEGATIVE] So, no, this policy doesn't cover durable medical equipment.
[CUSTOMER][NEUTRAL] So it's a non-covered policy, right?
[AGENT][NEUTRAL] Right. It's not covered by the patient's policy.
[CUSTOMER][NEUTRAL] Non-covered by the patient.
[AGENT][NEUTRAL] The patient's policy does not cover durable medical equipment.
[CUSTOMER][POSITIVE] No noncovered. OK, thank you so much. And can I have your uh name with the spelling?
[AGENT][NEUTRAL] Sure, my name is [PII] The first initial to my last name is [PII].
[CUSTOMER][NEUTRAL] And can I have the call reference number?
[AGENT][NEUTRAL] So there's no call reference number, but you can use my name in today's date.
[CUSTOMER][POSITIVE] OK, thank you for that information. Thank you for assisting your patience. Have a great day. Bye bye.
[AGENT][POSITIVE] Thank you you also and thanks for calling APL. Bye bye.
[CUSTOMER][POSITIVE] Thank you.