AccountId: 011433970860
ContactId: 864b1f49-7dbb-43bc-994b-f51b7655aa13
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 277660 ms
Total Talk Time (AGENT): 95862 ms
Total Talk Time (CUSTOMER): 73608 ms
Interruptions: 0
Overall Sentiment: AGENT=0.4, CUSTOMER=2.1
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/01/21/864b1f49-7dbb-43bc-994b-f51b7655aa13_20250121T13:15_UTC.wav
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[AGENT][NEUTRAL] For calling APL, this is [PII]. How may I help you?
[CUSTOMER][NEUTRAL] Hello, I'm calling from Century Medical and Dental Center. My name is [PII] and I would like to check eligibility for the patient. Could you please help me with this?
[AGENT][NEUTRAL] I can help you [PII]. What's the policy number?
[CUSTOMER][NEUTRAL] It is 02490697.
[AGENT][NEUTRAL] The phone number in case we're disconnected?
[CUSTOMER][NEUTRAL] Yes, uh, it is [PII].
[AGENT][POSITIVE] Thank you. One moment.
[CUSTOMER][POSITIVE] You're welcome.
[AGENT][NEUTRAL] Just a few minutes almost pulling up the files.
[CUSTOMER][POSITIVE] No problem.
[AGENT][NEUTRAL] And what is the patient's name and date of birth?
[CUSTOMER][NEUTRAL] First name, [PII], last name [PII], and date of birth is [PII].
[AGENT][NEUTRAL] OK, and did you say you needed just eligibility or eligibility and benefits?
[CUSTOMER][NEUTRAL] Eligibility and benefits if patient active.
[AGENT][NEUTRAL] OK, and are you from a medical provider's office or dental?
[CUSTOMER][NEUTRAL] Medical
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] So the policy effective date is [PII].
[CUSTOMER][NEUTRAL] Uh huh.
[AGENT][NEUTRAL] I do show the policy is currently active at this time. And what type of service is it for? Is it for service in a doctor's office?
[CUSTOMER][NEUTRAL] Yes, could you please verify benefits for office visit with PCP specialist and also diagnostic X-ray, please.
[AGENT][NEUTRAL] And what is the diagnostic test?
[CUSTOMER][NEUTRAL] Just general benefit, please.
[AGENT][NEUTRAL] OK, but there are diagnostic tests that are not covered. So what did you say it's for an X-ray?
[CUSTOMER][NEUTRAL] diagnostic test.
[CUSTOMER][POSITIVE] Yes, yes, X-ray.
[AGENT][NEUTRAL] OK, so the maximum benefit for service in a doctor's office to include any treatment is up to $75 per visit, a maximum of 5 visits per calendar year, and this information is verification only. It does not guarantee payment of a claim, and I don't show any of that benefit used at this time.
[CUSTOMER][NEUTRAL] Mm, got it.
[AGENT][NEUTRAL] Any other questions, [PII]?
[CUSTOMER][NEUTRAL] And for X-ray it will be the same, $75.
[AGENT][NEUTRAL] If it's being done in the office, the max is up to 75. Anything done during the visit is up to 75 per visit.
[CUSTOMER][NEUTRAL] Uh-huh.
[CUSTOMER][NEUTRAL] Uh-huh.
[CUSTOMER][POSITIVE] Mhm. I got it. Thank you so much. And uh one more question, uh, it is, is this insurance will be primary or secondary?
[AGENT][NEUTRAL] Mhm.
[AGENT][NEUTRAL] OK, so this is a limited hospital indemnity policy. Uh you'll need to verify with the patient as to whether they have other coverage or not to determine.
[AGENT][NEUTRAL] That to answer that question.
[CUSTOMER][NEUTRAL] Uh-huh.
[CUSTOMER][POSITIVE] OK, got it. Thank you so much. It's all I need and could you please repeat your name and address for this number for this call?
[AGENT][NEUTRAL] You'll use my name and today's date as reference for today's call, [PII].
[AGENT][NEUTRAL] [PII].
[AGENT][NEUTRAL] First initial of my last name is [PII], did you have any other questions I could help with today?
[CUSTOMER][POSITIVE] It's all I need. Thank you so much and have a nice day.
[AGENT][POSITIVE] You're welcome thanks for calling APL have a good day.
[CUSTOMER][POSITIVE] Thank you, take care, bye bye.