AccountId: 011433970860
ContactId: 984025ec-88d2-4049-9066-8043103cfd4f
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 269119 ms
Total Talk Time (AGENT): 156936 ms
Total Talk Time (CUSTOMER): 106499 ms
Interruptions: 2
Overall Sentiment: AGENT=0.7, CUSTOMER=0.3
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/04/23/984025ec-88d2-4049-9066-8043103cfd4f_20250423T18:05_UTC.wav
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[AGENT][NEUTRAL] Thank you for calling APL. This is [PII]. How can I help you?
[CUSTOMER][NEUTRAL] Hi, Ms. [PII], I just called. I was speaking with Ms. [PII], um, but I forgot to ask her what network do you all use?
[AGENT][NEUTRAL] Um, I can get that policy pulled up and check that for you. Um, what was your name?
[CUSTOMER][NEUTRAL] Uh-huh.
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] OK, [PII], can I get a good call back number from me first in case we're disconnected?
[CUSTOMER][NEUTRAL] [PII]
[AGENT][NEUTRAL] Thank you. And then do you have that policy number?
[CUSTOMER][NEUTRAL] Mm.
[CUSTOMER][NEUTRAL] Uh, the number that she told me to use was the, uh, excuse me, 02044285.
[AGENT][NEUTRAL] OK thank you one moment.
[CUSTOMER][NEUTRAL] Mm mhm.
[AGENT][NEUTRAL] OK, and then what was the name and date of birth for the patient?
[CUSTOMER][NEUTRAL] I believe it's [PII] can tell by [PII].
[AGENT][POSITIVE] Perfect, thank you for verifying that and this was for medical correct?
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] OK
[CUSTOMER][NEUTRAL] Yes.
[AGENT][NEUTRAL] OK, so yes, this is um a limited indemnity medical plan so it does not have a network it could be used anywhere you would just send the claim information directly to us.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] OK, got it.
[AGENT][NEUTRAL] I've got a mailing address, fax number or a payer ID if you need any of that.
[CUSTOMER][POSITIVE] Alrighty.
[CUSTOMER][NEUTRAL] No, we, I have it on the back of the card, and you said it's called a limited indemnity.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] Correct. Limited indemnity medical plan. Yes.
[CUSTOMER][NEUTRAL] Plan.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] Alright, was there anything else I could help you with [PII]?
[CUSTOMER][NEUTRAL] Alright, cause the
[CUSTOMER][NEUTRAL] Um, no, she gave me that the patient has medical benefits for admission up to $2000 a day. Um, is that all the medical benefits that they have? They're getting a CT done, so I guess it's covered under the.
[AGENT][NEUTRAL] Um,
[CUSTOMER][NEUTRAL] It's still covered under the medical.
[AGENT][NEUTRAL] I can get that pulled up. Give me just a moment.
[AGENT][NEUTRAL] All of these policies can be pretty different, so.
[CUSTOMER][NEUTRAL] OK. And the reason I'm checking, yeah, because I had a patient, I had a, my co-worker called you all earlier.
[AGENT][NEUTRAL] Sure.
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEGATIVE] And the patient told, the person told my representative that he had no medical benefits.
[AGENT][NEUTRAL] Uh, for this policy or for this member?
[CUSTOMER][NEUTRAL] Mhm. Yes, yes.
[AGENT][NEUTRAL] Yeah, it's a
[CUSTOMER][NEUTRAL] He only had dental and vision, I think she said.
[AGENT][NEUTRAL] Oh no, no, no, this for this member, yeah, that this, the policy number you gave me is this limited indemnity medical plan and it is a bit different, of course it's not like um traditional major medical, um, in the fact that if it is limited as to what is and is not covered and then um it just pays a set dollar amount per covered procedure and um or office visit. Uh, so, OK, I do have that uh.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] Um, and of course I will let you know verification of coverage is not a guarantee of paying for claims. Uh, so they have, um, hospital admission, yes, $2000 maximum per day, um, that's one day per calendar year. Um, excuse me, hospital consignment. So if they were confined up to a maximum of 30 days, that is $200 per day. Also has an intensive care benefit, rehab, um, accident and surgical or excuse me, accident and sickness surgical benefit.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Mm.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] And then several um outpatient benefits such as emergency room, urgent care, um, and then there is a diagnostic testing benefit as well, uh, specifically for medical imaging tests and then.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Yeah, that's what I was calling.
[AGENT][NEUTRAL] Yes, and um what, yes, that is for medical imaging um that is $400 per day again maximum of 1 day per calendar year and then if it requires um a follow up or an advanced study, yes, so if it requires an advanced study or a follow up, that's an additional $100 again limited to one,
[CUSTOMER][NEUTRAL] The imaging. Mhm.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Right, mhm, and he hasn't exhausted that.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] And then anything else that's ambulance and then um preventative elective surgery. So that's going to be the extent of this policy.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][POSITIVE] Got it thank you so much for your help. I appreciate that.
[AGENT][NEUTRAL] Right, bit confusing. Yeah, absolutely. Did you have any other questions for me?
[CUSTOMER][POSITIVE] Oh yeah, yes, ma'am. Thank you.
[AGENT][POSITIVE] Alright yeah thanks for giving us a call alright have a great rest of your day.
[CUSTOMER][NEUTRAL] No, thank you.
[CUSTOMER][NEUTRAL] You too bye bye.
[AGENT][POSITIVE] Thank you. Bye-bye