AccountId: 011433970860
ContactId: 8d930124-36e6-4996-bf75-80d88784ccd7
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 229210 ms
Total Talk Time (AGENT): 121600 ms
Total Talk Time (CUSTOMER): 70749 ms
Interruptions: 0
Overall Sentiment: AGENT=0.4, CUSTOMER=1.7
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/04/22/8d930124-36e6-4996-bf75-80d88784ccd7_20250422T14:54_UTC.wav
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[AGENT][NEUTRAL] Thank you for calling APL. This is [PII]. How may I help you?
[CUSTOMER][NEUTRAL] Hi [PII], my name is [PII]. Last initial [PII] I'm calling from a provider's office to determine a patient's benefits.
[AGENT][NEUTRAL] OK, I can help you with benefits, Ms. [PII]. um, can I please get your callback number just in case our call is disconnected?
[CUSTOMER][NEUTRAL] Yes, that is [PII].
[AGENT][NEUTRAL] OK, thank you. And then what is the patient's name, date of birth, and policy number?
[CUSTOMER][NEUTRAL] Uh, name is [PII]. Uh, date of birth is [PII], and I do have a social on file for his ID.
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] That is [PII].
[AGENT][POSITIVE] OK, thank you so much and I'm gonna look that up it's gonna be a quick hold for you.
[CUSTOMER][NEGATIVE] You are on hold.
[AGENT][NEUTRAL] Hey, [PII].
[AGENT][NEUTRAL] Turn off the dryer until she gets done. The lights blinked.
[AGENT][NEUTRAL] Her back on when she's done.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] Let me look up that social.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] OK, I've got [PII] pulled up now. Is this going to be a dental claim or is it going to be a medical claim? I mean.
[CUSTOMER][NEUTRAL] This will be medical, so he is having, he is scheduled for outpatient surgery. Um, this appears to be a is this a limited benefit plan? Uh, it looks like a hospital indemnity plan, OK.
[AGENT][NEUTRAL] Benefits
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] Yes, ma'am.
[AGENT][NEUTRAL] Yes, ma'am. He does have an active policy. His effective date is [PII], and you are correct, this is a limited benefit hospital indemnity plan.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] And let me check his benefits for you real quick. And you said he's going to be having an outpatient surgery?
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][POSITIVE] Thank you.
[CUSTOMER][POSITIVE] Correct.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] He does have, uh, and this is just verify benefits, it's not a guarantee of payment. He does have outpatient accident sickness surgical benefit in a physician's office, 2 per calendar year.
[AGENT][NEUTRAL] Or in a facility.
[CUSTOMER][NEUTRAL] And um OK.
[AGENT][NEUTRAL] Or in a facility he gets one per calendar year in the facility it pays $250 and in the physician's office it pays $125.
[CUSTOMER][NEUTRAL] OK, go ahead.
[CUSTOMER][NEUTRAL] And then anything left is patient responsibility?
[AGENT][NEUTRAL] We don't ever give patient responsibility. Uh, we let the provider determine that because we don't know if you guys are gonna give discounts or or something like that so we we always let you guys decide.
[CUSTOMER][POSITIVE] Got you.
[CUSTOMER][NEUTRAL] OK
[CUSTOMER][NEUTRAL] OK, um, and then as far as pre-certification goes, um, is that something that you require?
[AGENT][NEUTRAL] No, ma'am. It does not need pre-certification. This is not a major medical insurance.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK, got you.
[CUSTOMER][POSITIVE] All right [PII] well thank you so much. I just need a call reference number.
[AGENT][NEUTRAL] Yes, ma'am. You can use my name, [PII] in today's date.
[CUSTOMER][POSITIVE] All right thanks again have a good one.
[AGENT][POSITIVE] You're very welcome, Miss [PII]. I hope you have a good rest of your week and we thank you for calling APL.
[CUSTOMER][POSITIVE] Thank you bye bye.
[AGENT][NEUTRAL] Bye bye.