AccountId: 011433970860
ContactId: 866c6eb9-fcfe-4283-8de9-2e50621edc2a
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 307709 ms
Total Talk Time (AGENT): 157008 ms
Total Talk Time (CUSTOMER): 73530 ms
Interruptions: 0
Overall Sentiment: AGENT=1.6, CUSTOMER=2
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/01/03/866c6eb9-fcfe-4283-8de9-2e50621edc2a_20250103T13:47_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, good morning. I'm calling from Pmont Urgent Care, just calling to verify, um, and see if, uh, eligibility for a patient.
[AGENT][NEUTRAL] OK, you only need to verify the policy is active. You do not need benefits. Is that correct?
[CUSTOMER][NEUTRAL] Correct and if he has like any co-pay or deductible or anything like that.
[AGENT][POSITIVE] Yes, I can help you. And who am I speaking with?
[CUSTOMER][NEUTRAL] My name is [PII].
[AGENT][NEUTRAL] I'm sorry, [PII].
[CUSTOMER][NEUTRAL] Yes
[AGENT][NEUTRAL] OK, thank you. And your callback number, please?
[CUSTOMER][NEUTRAL] It is [PII].
[AGENT][NEUTRAL] Thank you and the member's policy number, please, [PII].
[CUSTOMER][NEUTRAL] Yes ma'am it is give me one moment.
[AGENT][NEUTRAL] Uh-huh.
[CUSTOMER][NEUTRAL] It's 02567400.
[AGENT][POSITIVE] Thank you. One moment, please.
[CUSTOMER][POSITIVE] Thank you.
[AGENT][POSITIVE] You're welcome.
[AGENT][NEUTRAL] OK, and [PII], any information that I did provide for you today will be a verification of benefits and not a guarantee of payment. What is your patient's name and their date of birth?
[CUSTOMER][NEUTRAL] Patient's name is [PII]. Date of birth is [PII].
[AGENT][NEUTRAL] OK, thank you. So I do show that he is the subscriber on this hospital indemnity limited benefit plan.
[AGENT][NEUTRAL] And this policy is active with an effective date of [PII].
[AGENT][NEUTRAL] Again, [PII], this is not a major medical insurance plan. This is a limited benefit plan.
[AGENT][NEUTRAL] So there is no co-pays. Um, what type of service is this for inpatient, outpatient or office?
[CUSTOMER][NEUTRAL] Um, it's urgent care.
[AGENT][NEUTRAL] OK. So um for his outpatient accident and sickness treatment benefit for an urgent care facility, the benefit amount is $50 per day and a maximum of 4 days per calendar year per covered person.
[CUSTOMER][NEUTRAL] Oh
[CUSTOMER][NEUTRAL] OK
[CUSTOMER][NEUTRAL] $50.
[AGENT][NEUTRAL] Is what mhm the benefit amount is on this plan for an urgent care visit.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK
[CUSTOMER][POSITIVE] I'm so sorry, give me just one second.
[AGENT][NEUTRAL] Yes, ma'am.
[CUSTOMER][NEUTRAL] Um, and I don't know if you can confirm this, but can you see if this insurance is in network with our, um, I guess facility?
[AGENT][NEUTRAL] So this network, this plan participates with the multi-plan network and if you don't know if you all are affiliated with the multiplan, I can give you their phone number and then I can also connect you with them Gia.
[CUSTOMER][NEUTRAL] OK, yes ma'am.
[AGENT][NEUTRAL] So their phone number is [PII].
[AGENT][NEUTRAL] [PII].
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] And then once the claim has been received and processed by APL we do have a portal that you can create a username and a password for to have access to the explanation of benefits.
[AGENT][POSITIVE] And that website for us is secured.
[AGENT][NEUTRAL] [PII]
[AGENT][NEUTRAL] [PII].
[CUSTOMER][NEUTRAL] OK
[CUSTOMER][POSITIVE] Perfect.
[AGENT][NEUTRAL] OK. And is there anything else I can help you with before I connect you over to multiplan?
[CUSTOMER][POSITIVE] Um, no, ma'am, that'll be all. Thank you so much.
[AGENT][POSITIVE] OK. Well, you are very welcome and thank you for calling APL. I hope that you have a very nice day.
[CUSTOMER][POSITIVE] Likewise, and I'm so sorry, is there a confirmation number by chance that I can get?
[AGENT][NEUTRAL] Yes sir.
[AGENT][NEUTRAL] You would use my name, my name that I gave you along with today's date.
[CUSTOMER][POSITIVE] OK awesome thank you.
[AGENT][POSITIVE] You're welcome. And again, thank you for calling APL. Have a wonderful day.
[CUSTOMER][NEUTRAL] You too.
[AGENT][POSITIVE] Thank you. One moment, please.
[CUSTOMER][POSITIVE] OK thank you.