AccountId: 011433970860
ContactId: 8e3ba6e1-77b9-4a87-bc8f-f730cbfd672e
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 312420 ms
Total Talk Time (AGENT): 142343 ms
Total Talk Time (CUSTOMER): 86105 ms
Interruptions: 1
Overall Sentiment: AGENT=0.7, CUSTOMER=1.9
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/06/03/8e3ba6e1-77b9-4a87-bc8f-f730cbfd672e_20250603T14:49_UTC.wav
--------------------------------------------
[AGENT][NEUTRAL] Thank you for calling APL. This is [PII]. How may I help you?
[CUSTOMER][NEUTRAL] Hi, um, my name is [PII] and I am calling uh um to check benefits for a member.
[AGENT][NEUTRAL] OK, Miss [PII], I can.
[CUSTOMER][NEUTRAL] And did you say your name is [PII]?
[AGENT][NEUTRAL] Yes, ma'am.
[CUSTOMER][POSITIVE] Thank you.
[AGENT][POSITIVE] You're welcome and I can help you with the benefits, Miss [PII]. Can I please get your callback number first just in case the calls dropped, I can call you back.
[CUSTOMER][NEUTRAL] Absolutely it's [PII].
[AGENT][NEUTRAL] Thank you, and then what is the name of the facility you're calling from?
[CUSTOMER][NEUTRAL] Elements Regional Medical Center.
[AGENT][NEUTRAL] OK. And then may I please get the member's uh name, date of birth, and policy number for the patient?
[CUSTOMER][NEUTRAL] Sure, it's [PII]. Date of birth is [PII], and the ID number is 02624488.
[AGENT][NEUTRAL] OK, let me pull up her policy for us real quick.
[AGENT][NEUTRAL] OK, I do show that Ms. [PII] does have an active policy. Her effective date is [PII].
[AGENT][NEUTRAL] And
[AGENT][NEUTRAL] The benefits that you're looking for, is it inpatient or outpatient?
[CUSTOMER][NEUTRAL] Outpatient.
[AGENT][NEUTRAL] OK, let me get her.
[AGENT][NEUTRAL] Outpatient benefits and what type of facility are you or ambulatory urgent care, ER physician's office?
[CUSTOMER][NEUTRAL] Outpatient facility.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] Alright, so on her policy this is uh to verify her benefits, it's not a guarantee of payment. She has a limited hospital indemnity plan.
[AGENT][NEUTRAL] She has, um, it's broke down by facility for an ER. She gets um outpatient accident sickness treatment benefit of $50.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] An urgent care center, she gets 4 visits per year for accident and sickness and that also pays $50. She can go to a physician's office 4 times a year and that pays $50.
[CUSTOMER][NEUTRAL] OK, that's uh.
[CUSTOMER][NEUTRAL] That is not really.
[CUSTOMER][NEUTRAL] What we need, we need uh outpatient physical therapy benefits.
[AGENT][NEUTRAL] OK. She does have physical therapy benefits. She gets 4 visits a year and it pays $30.
[CUSTOMER][NEUTRAL] So to be clear, she only has 4 visits of physical therapy per year.
[AGENT][NEUTRAL] Yes ma'am.
[CUSTOMER][NEUTRAL] And you said it pays $30 does that mean there's a $30 co-pay or that's all that you will pay toward the bill?
[AGENT][NEUTRAL] Right, that's all we pay towards the bill.
[CUSTOMER][POSITIVE] OK, that's interesting alright.
[CUSTOMER][NEUTRAL] Is there a deductible or out of pocket maximum or anything of that nature?
[AGENT][NEUTRAL] No, ma'am.
[CUSTOMER][NEUTRAL] OK and uh.
[CUSTOMER][NEUTRAL] Is this a calendar year plan or?
[CUSTOMER][NEUTRAL] Uh, is it on a plan year?
[AGENT][NEUTRAL] Yes, it's calendar year, um, and she begins like her effective date is um [PII], so she gets new benefits, um.
[CUSTOMER][NEUTRAL] OK
[AGENT][NEUTRAL] [PII] every year, yes ma'am, yes.
[CUSTOMER][NEUTRAL] At the end of the year, at the beginning of.
[CUSTOMER][NEUTRAL] OK
[CUSTOMER][POSITIVE] Alright and uh if I could get a reference number for this call, that would be great.
[AGENT][NEUTRAL] Yes, you can use my name [PII] and today's date.
[CUSTOMER][NEUTRAL] OK
[CUSTOMER][POSITIVE] Thank you very much I appreciate your help with this today.
[AGENT][POSITIVE] You're very welcome, Miss [PII]. Is that everything I can help you with before we go?
[CUSTOMER][POSITIVE] Thank you.
[CUSTOMER][POSITIVE] That is definitely everything I need, thank you.
[AGENT][POSITIVE] OK, well you have a blessed night and thank you for calling APL.
[CUSTOMER][POSITIVE] Thank you you too bye bye.
[AGENT][NEUTRAL] Mhm.