AccountId: 011433970860
ContactId: 91df6463-c118-4d41-b3e5-a0b87312bd8d
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 462200 ms
Total Talk Time (AGENT): 188756 ms
Total Talk Time (CUSTOMER): 164880 ms
Interruptions: 2
Overall Sentiment: AGENT=1.2, CUSTOMER=0.5
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/04/23/91df6463-c118-4d41-b3e5-a0b87312bd8d_20250423T17:55_UTC.wav
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[AGENT][NEUTRAL] Thank you for calling APL. This is [PII]. How can I help you?
[CUSTOMER][NEUTRAL] Good afternoon, Ms. [PII]. My name is [PII]. I'm calling from Norton Healthcare to to get benefits and accumulations for the patient.
[AGENT][POSITIVE] OK, I'm happy to check on benefits. What's your policy number?
[CUSTOMER][NEUTRAL] I have D as in dog 459-03841.
[AGENT][NEUTRAL] OK, um, unfortunately, I can't pull them with that number. Do you have their name or social? I can check by that.
[CUSTOMER][NEUTRAL] Sure, um, let me see, let me go back and look at their card and see if that's the number that's on their card.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] No worries. If you see anything that says like certificate, like in hospital or outpatient, that's.
[CUSTOMER][NEUTRAL] Uh, come on.
[CUSTOMER][NEUTRAL] Yeah.
[AGENT][NEUTRAL] What we would need.
[CUSTOMER][NEUTRAL] I see policy er number is that?
[AGENT][NEUTRAL] Mhm.
[AGENT][NEUTRAL] Does this start with like a 0?
[CUSTOMER][NEUTRAL] What, that's the number you need or the
[AGENT][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] Yes ma'am.
[AGENT][POSITIVE] Yeah, give me that one.
[CUSTOMER][NEUTRAL] 02044265
[AGENT][POSITIVE] OK, yeah, that sounds great.
[CUSTOMER][NEUTRAL] OK, so we should be using that number, not the medical ID number.
[AGENT][NEUTRAL] Let me see here. What's the patient's name and date of birth?
[CUSTOMER][NEUTRAL] Uh, [PII].
[CUSTOMER][NEUTRAL] Uh, [PII].
[AGENT][NEUTRAL] Alright, let me read this back to you. I copy down [PII].
[CUSTOMER][NEUTRAL] Yes.
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] That's not it either.
[AGENT][NEUTRAL] Doesn't
[CUSTOMER][NEUTRAL] What's going on?
[AGENT][NEUTRAL] Let me try it again here 02044.
[CUSTOMER][NEUTRAL] 020442, that might be 285, I'm sorry, it could be 8, the card is scanned in and it looks like it.
[AGENT][NEUTRAL] That's OK.
[AGENT][POSITIVE] No worries, yeah, that's OK. It is an 8. It's an 8 instead of a 6 that brought him up.
[CUSTOMER][NEUTRAL] It looks like a 6, but it.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][POSITIVE] OK, I'm sorry. Yeah, I'm sorry.
[AGENT][NEUTRAL] No, it's totally, totally fine. Um, OK, so patients active, his effective date on here is [PII].
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] It's a limited benefit plan. So is he being seen for like an office visit?
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Mm, a CT.
[AGENT][NEUTRAL] CT OK, let me see what the.
[CUSTOMER][NEUTRAL] A CAT scan. Mhm, mhm.
[AGENT][NEUTRAL] Benefits are I'm here for that. One second.
[AGENT][NEUTRAL] OK. So CT scans are listed under medical imaging test, so that's good. Let's see what the benefit is.
[AGENT][NEUTRAL] All right. So under the diagnostic testing benefit, the plan pays for medical imaging test, a maximum of $400 per day. A patient is allowed one test, it looks like per calendar year, like per calendar day.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] I don't show.
[CUSTOMER][NEUTRAL] And has he used that?
[AGENT][NEUTRAL] Uh, I don't show, yeah, I don't show he's used it, so.
[CUSTOMER][NEUTRAL] Be I
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK
[CUSTOMER][POSITIVE] Thank you.
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] And does the patient have medical benefits?
[AGENT][NEUTRAL] Yes.
[CUSTOMER][NEUTRAL] Like hospital
[AGENT][NEUTRAL] Yeah, so this does also cause, uh, excuse me, cover hospital like admission or confinement. I can give you that if you would need that.
[CUSTOMER][NEUTRAL] I'm gonna, yeah, I'm gonna just go ahead and put it in the notes, OK, patient.
[AGENT][NEUTRAL] Yeah.
[CUSTOMER][POSITIVE] Has medical benefits.
[CUSTOMER][NEUTRAL] And you said for admission?
[AGENT][NEUTRAL] Mhm. So the hospital admission benefit is $2000.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] And that's a maximum of one day.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] And then confinement is gonna be $200 per day.
[AGENT][NEUTRAL] And it's a maximum of 30 days, it looks like.
[CUSTOMER][POSITIVE] Thank
[CUSTOMER][NEUTRAL] Um
[CUSTOMER][NEUTRAL] Um,
[CUSTOMER][NEUTRAL] Oh, I'm sorry, you said 30 days max.
[CUSTOMER][NEUTRAL] Because I was, this patient called earlier.
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] But a previous representative called you guys to get information on this patient.
[CUSTOMER][NEUTRAL] For a.
[CUSTOMER][NEUTRAL] He had a couple of things going, a CT.
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] For his cardiologist.
[CUSTOMER][NEUTRAL] And whoever she spoke to said the patient.
[CUSTOMER][NEUTRAL] Had no medical benefits at all, just dental and something else, I think she said.
[AGENT][NEUTRAL] Hm.
[AGENT][NEUTRAL] No, I mean, this is a limited benefit medical plan that was effective [PII].
[CUSTOMER][NEUTRAL] Hm.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] Um, I mean,
[AGENT][NEUTRAL] Yeah, they, I mean they do have dental with us, but yeah. So it's not.
[CUSTOMER][NEUTRAL] OK, I'm gonna put that in here too.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] Consider like major medical. It's um a limited benefit policy, so maybe that's what they meant by it.
[CUSTOMER][NEUTRAL] Um,
[CUSTOMER][NEUTRAL] Right.
[CUSTOMER][NEUTRAL] Mm.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Let me put this in.
[CUSTOMER][NEUTRAL] Mm
[CUSTOMER][NEUTRAL] OK. And can you spell your first name for me, please?
[AGENT][POSITIVE] Absolutely. My name is spelled [PII].
[CUSTOMER][NEUTRAL] OK, and your last name initial?
[AGENT][NEUTRAL] It's gonna be [PII].
[CUSTOMER][NEUTRAL] Thank you and Miss [PII], do you have a reference number for this call?
[AGENT][POSITIVE] You're welcome.
[AGENT][POSITIVE] Absolutely. Call references my name with my initial to my last name and then just put today's date.
[CUSTOMER][NEUTRAL] OK
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][POSITIVE] Awesome, thank you so much.
[AGENT][POSITIVE] You're welcome. Have a great day.
[CUSTOMER][POSITIVE] All right. You too, thank you. Mm bye bye.
[AGENT][NEUTRAL] Bye-bye.
[AGENT][NEUTRAL] Oh, OK.