AccountId: 011433970860
ContactId: 84c7df4d-5196-486a-934e-055ba700eecc
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 208809 ms
Total Talk Time (AGENT): 88272 ms
Total Talk Time (CUSTOMER): 42391 ms
Interruptions: 0
Overall Sentiment: AGENT=0.2, CUSTOMER=0.9
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/06/05/84c7df4d-5196-486a-934e-055ba700eecc_20250605T13:36_UTC.wav
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[AGENT][POSITIVE] Good morning. Thanks for calling APL. This is [PII]. May I help you?
[CUSTOMER][NEUTRAL] Hi, my name is [PII] and I'm calling from Guysinger Clinic. I was trying to verify if a member had benefits.
[AGENT][NEUTRAL] OK, yes, ma'am. I can verify benefits for you. And you say your name is [PII]?
[CUSTOMER][NEUTRAL] Just [PII].
[AGENT][NEUTRAL] Oh, [PII], I'm sorry.
[AGENT][NEUTRAL] And what is that policy number, please?
[CUSTOMER][NEUTRAL] That's OK.
[CUSTOMER][NEUTRAL] 026068889
[AGENT][NEUTRAL] Thank you. And do you have a callback number in case the call drops?
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] Thank you. And the patient's name, date of birth.
[AGENT][NEUTRAL] Excuse me.
[CUSTOMER][NEUTRAL] [PII] and it's [PII].
[AGENT][NEUTRAL] OK, I'm showing his effective date is [PII] of this year, and he is active and what benefits are needed, Ms. [PII]?
[AGENT][NEUTRAL] Excuse me, I'm sorry.
[CUSTOMER][NEUTRAL] Um, medical, it'll be medical benefits, that's OK, um.
[CUSTOMER][NEUTRAL] Give me 1 2nd.
[CUSTOMER][NEUTRAL] Yeah, um, data services 5125.
[CUSTOMER][NEUTRAL] And it's for an emergency room visit.
[AGENT][NEUTRAL] Uh let's see.
[AGENT][NEUTRAL] 01 I'm gonna have to pull up the plan.
[AGENT][NEGATIVE] And come on.
[AGENT][NEUTRAL] And this is for ER for sickness?
[CUSTOMER][NEUTRAL] It's for the physician portion for the professional.
[CUSTOMER][NEUTRAL] And it's an emergency visit. It looks like you had a CAT scan and an EKG.
[AGENT][NEUTRAL] Um,
[AGENT][NEUTRAL] Uh, let me see.
[AGENT][NEUTRAL] Sorry, it's taking a while, but this insurance policy, the type of policy I have is a hospital indemnity plan. So it's very limited as far as benefits that are covered.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] Uh
[AGENT][NEUTRAL] OK, um, not a guarantee of payment, just a verification of coverage for emergency room, the max payable is $350 per calendar day. We have one per year.
[AGENT][NEUTRAL] So essentially $350 per calendar year for ER.
[CUSTOMER][NEUTRAL] OK, and can you tell me where the claim should be sent?
[AGENT][NEUTRAL] Uh, yes, [PII].
[AGENT][NEUTRAL] [PII].
[AGENT][NEUTRAL] [PII].
[CUSTOMER][POSITIVE] OK, thank you so much for your help.
[AGENT][POSITIVE] Oh, you're welcome and thanks for calling APL. Have a great day.
[CUSTOMER][POSITIVE] Thanks you too bye bye.
[AGENT][NEUTRAL] Mm bye.