AccountId: 011433970860
ContactId: 8df8fc36-ea41-4bb3-b9d9-f12f6d70c5e2
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 262260 ms
Total Talk Time (AGENT): 121966 ms
Total Talk Time (CUSTOMER): 91420 ms
Interruptions: 1
Overall Sentiment: AGENT=0.3, CUSTOMER=0
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/03/19/8df8fc36-ea41-4bb3-b9d9-f12f6d70c5e2_20250319T21:11_UTC.wav
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[AGENT][POSITIVE] Good afternoon. Thank you for calling APL. This is [PII]. How may I assist you?
[CUSTOMER][NEUTRAL] Hello, this is [PII]. Hello, my last name is [PII]. I'm calling from provider's office. I'm looking for the patient's eligibility and benefits from
[CUSTOMER][NEUTRAL] Medical.
[AGENT][NEUTRAL] OK. Sure, I can assist you with the eligibility and benefits, Mr. [PII]. May I have a callback number just in case we get disconnected?
[CUSTOMER][NEUTRAL] Yeah, it's [PII]. It's a direct line.
[AGENT][NEUTRAL] Thank you. And may I have the patient's policy number?
[CUSTOMER][NEUTRAL] 02606091.
[AGENT][NEUTRAL] OK. And what's the name of the facility you're calling from, Mr. [PII]?
[CUSTOMER][NEUTRAL] Memorial City Cardiology Associates.
[AGENT][POSITIVE] Thank you.
[AGENT][NEUTRAL] One.
[AGENT][NEUTRAL] May I have the name and date of birth of the patient?
[CUSTOMER][NEUTRAL] [PII] and the date of birth is [PII].
[AGENT][NEUTRAL] OK, thank you. And um so this is gonna be for an office visit?
[CUSTOMER][NEUTRAL] Yes.
[AGENT][NEUTRAL] OK. We have an effective date of [PII]. It is active at the moment and this is one of our limited hospital indemnity plan, and this is not a guarantee of payment, just a verification of coverage and that's just a disclaimer. And with this one, we cover, yeah, go ahead.
[CUSTOMER][NEUTRAL] Yeah, what
[CUSTOMER][NEUTRAL] What's the plant type it is?
[CUSTOMER][NEUTRAL] It's a BPO or like.
[AGENT][NEUTRAL] This is
[AGENT][NEUTRAL] It's a commercial plan. It's a, it's a limited hospital indemnity plan.
[CUSTOMER][NEUTRAL] Commercial plan.
[AGENT][NEUTRAL] Yes.
[CUSTOMER][NEUTRAL] OK
[AGENT][NEUTRAL] OK, and this one pays 75.
[CUSTOMER][NEUTRAL] Commercial indemnity.
[AGENT][NEUTRAL] I'm sorry?
[CUSTOMER][NEUTRAL] Indemnity kind of
[CUSTOMER][NEUTRAL] And, right?
[AGENT][NEUTRAL] I'm sorry, I'm not understanding what you're saying.
[CUSTOMER][NEUTRAL] OK. May I know the specialist?
[CUSTOMER][NEUTRAL] Yeah, nothing, nothing. Can you go ahead.
[AGENT][NEUTRAL] OK, um, so this policy pays $75 per visit.
[AGENT][NEUTRAL] Maximum of 3 visits, I'm sorry, 4 visits per person per calendar year. So that is the maximum benefit that we cover is just $75.
[CUSTOMER][NEUTRAL] For
[CUSTOMER][NEUTRAL] 4 digits, right?
[AGENT][NEUTRAL] Mhm. 4 visits per covered person per calendar year.
[CUSTOMER][NEUTRAL] Covered by, covered?
[CUSTOMER][NEUTRAL] For is it covered per year, right?
[AGENT][POSITIVE] Correct.
[CUSTOMER][NEUTRAL] OK. May I know the benefits for the coats, I mean, CPT codes?
[AGENT][NEUTRAL] Benefits for the city we cover the office visit.
[CUSTOMER][NEUTRAL] They will cover the CPT code.
[CUSTOMER][NEUTRAL] Yeah, pro cos.
[AGENT][NEUTRAL] We covered the office visit, so that, that is the $75 for the visit, OK?
[CUSTOMER][NEGATIVE] Not special uh.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] $75 for the visit for visit covered by year.
[AGENT][POSITIVE] Correct, yes. Mhm.
[CUSTOMER][NEUTRAL] Yeah. May I know the, um, is there any deductible and out of pocket amount for this?
[AGENT][NEGATIVE] Not for this one, this one pays just a flat amount.
[CUSTOMER][NEUTRAL] OK. The provider is the network, right? With the patient plan?
[AGENT][NEGATIVE] There, there's no network.
[CUSTOMER][NEUTRAL] Thank you. Uh, can you please verify that alteration is required or not for the courts?
[AGENT][NEUTRAL] Yeah
[AGENT][NEUTRAL] Authorization is not required.
[CUSTOMER][NEUTRAL] OK. Thank you. May I know the color reference number for this call?
[AGENT][NEUTRAL] It's, it's just a limited policy.
[AGENT][NEUTRAL] We don't have reference numbers. You can use my name in today's date if you would like, Mr. [PII].
[CUSTOMER][NEUTRAL] Can you please spell out your name?
[AGENT][NEUTRAL] Sure, that's [PII]. Last initial is [PII].
[CUSTOMER][POSITIVE] Thank you. So, uh, and have a great day and take care. Bye for now.
[AGENT][NEUTRAL] Mm
[AGENT][POSITIVE] Mm, you as well and thank you for calling APL. Goodbye, Mr. [PII].
[CUSTOMER][NEUTRAL] Bye bye.
[AGENT][NEUTRAL] Bye.