AccountId: 011433970860
ContactId: 987291d0-1168-4fc8-b251-13cc7eda9203
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 444720 ms
Total Talk Time (AGENT): 194422 ms
Total Talk Time (CUSTOMER): 184721 ms
Interruptions: 8
Overall Sentiment: AGENT=0.4, CUSTOMER=0.7
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/04/02/987291d0-1168-4fc8-b251-13cc7eda9203_20250402T19:41_UTC.wav
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[AGENT][NEUTRAL] Good afternoon. Thank you for calling APL. This is [PII]. How may I help you today?
[CUSTOMER][NEUTRAL] Miss [PII], hey, this is [PII] calling with Augusta Surgical Group. I'm trying to determine a patient's benefit information. She's got two cards, and I, I don't know if one's maybe no longer valid and then the other card trumps the other card, but one card says 90 degree benefits.
[CUSTOMER][NEUTRAL] And then on the other side it has MAU workforce with an employee ID number and then this other card has APL so I didn't know if there are two types of coverages or if it's one is an old card and one's a new card.
[AGENT][NEUTRAL] Hm.
[AGENT][NEUTRAL] Yeah.
[AGENT][NEUTRAL] Well, let's say, [PII], did you see anything that says certificate number? It's gonna be like an eight digit number. It starts with 0102.
[CUSTOMER][NEUTRAL] Um, well, the one card has got an employee ID number with a D, and then it's got numbers following that on that one side on the other side, um, yeah, that's it because it says the members section, a pharmacy section, the medical section, but the only ID number on it for member is the D437-07993 and it has employee name and medical coverage employee.
[AGENT][NEUTRAL] Yeah, unless they.
[CUSTOMER][NEUTRAL] And it's got a group number, but the other one, the APL card.
[AGENT][NEUTRAL] Yeah, that D number is their ID number at work. What does it say on it?
[CUSTOMER][NEUTRAL] OK, so that's a work ID.
[CUSTOMER][NEUTRAL] Um, the work ID is D4.
[AGENT][NEUTRAL] That day number is, yeah.
[CUSTOMER][NEUTRAL] Did you need that number you're saying, or?
[AGENT][NEUTRAL] No, ma'am, no ma'am. I can't pull anything up by that, but uh do you see that APL number? Does it say, do you see a certificate number?
[CUSTOMER][NEUTRAL] No ma'am.
[CUSTOMER][NEUTRAL] Yeah, I do see, yeah.
[CUSTOMER][NEUTRAL] Yeah, I do see that that's a 258-6493.
[AGENT][NEUTRAL] That's ours. OK, let me get that keyed in, [PII]. Now while I'm doing that, [PII], go ahead and give me a good return telephone call number.
[CUSTOMER][NEUTRAL] Um, it's [PII].
[AGENT][NEUTRAL] [PII]. OK. All right, that policy number did come up. Now, what's your patient's name and date of birth?
[CUSTOMER][NEUTRAL] Um [PII]. Um, I can spell it for you. The first name is spelled [PII] Last name is [PII]
[AGENT][NEUTRAL] And date of birth.
[CUSTOMER][NEUTRAL] Um [PII].
[AGENT][NEUTRAL] OK, alright, thank you for all that information, [PII]. Now it looks like she is the insured on this hospital indemnity plan here at APL. I do show that it went into effect [PII]. She is current and active, but I must advise that verification of coverage is not a guarantee of payment on a claim. But you did say, are you just taking eligibility or do you want to know if a particular item is covered?
[CUSTOMER][NEUTRAL] Am I in it?
[CUSTOMER][NEUTRAL] Well
[CUSTOMER][NEUTRAL] Well, um, well, I just was confused because the two different cards that she presented, um, there's an APO card and then that 90 degree card, so is one is there different types of coverages or different types of policies on this plan or something?
[AGENT][NEUTRAL] Yeah.
[AGENT][NEUTRAL] Uh, I don't know what the 90 degree card is, but, uh, but the card with the certificate number on that you just gave me is her hospital indemnity benefit plan here.
[CUSTOMER][NEUTRAL] Uh-huh.
[CUSTOMER][NEUTRAL] So this is a hospital indemnity, OK, hospital in indemnity.
[AGENT][NEUTRAL] Mhm. Yes, ma'am, just pays base benefits on certain things, but yes ma'am.
[AGENT][NEUTRAL] Is there anything else I can help answer for you today, [PII]?
[CUSTOMER][NEUTRAL] You did [PII], you still there?
[AGENT][NEUTRAL] Yes, ma'am. I say, I don't know what happened. Yes, ma'am, I'm still here. I said, is that all I can answer for you today?
[CUSTOMER][NEUTRAL] Yeah
[CUSTOMER][NEUTRAL] I'm sorry, I couldn't hear you there, um, but I just wanna make sure with the hospital indemnity plan, does it cover office visits as well, like for her to see an off uh a specialist in the office.
[AGENT][NEUTRAL] Uh, let's see.
[AGENT][NEUTRAL] Mhm
[AGENT][NEUTRAL] Oh, I don't think so, but hang on, let me double check and get their benefit pack pulled up. Hang on just a second. I'm on.
[CUSTOMER][NEUTRAL] OK, yes ma'am.
[AGENT][NEUTRAL] Double check for you. I don't think they do, but I'm gonna make sure right quick.
[AGENT][NEUTRAL] Let's see.
[AGENT][NEUTRAL] Mm.
[AGENT][NEUTRAL] Is it
[AGENT][NEUTRAL] Is she coming in for sickness or wellness?
[CUSTOMER][NEUTRAL] Um, for, uh, [PII].
[AGENT][NEUTRAL] OK, because it looks like she does have a 56 office visits payable per calendar year that we pay a flat fee of $75 on. That's it.
[CUSTOMER][NEUTRAL] So
[CUSTOMER][NEUTRAL] That
[CUSTOMER][NEUTRAL] $25 flat fee OK.
[AGENT][NEUTRAL] Yes, ma'am.
[CUSTOMER][NEUTRAL] Um, nothing additional.
[CUSTOMER][NEUTRAL] Additional, OK, alright, and then 56 visits, OK, 6 visits and as far as you know those 5 are still available or has she used them all up yet?
[AGENT][NEUTRAL] Let's see.
[AGENT][NEUTRAL] Mm.
[AGENT][NEUTRAL] As of today, she's not used them all up. Mm mm.
[AGENT][NEUTRAL] Just as of today then. OK.
[CUSTOMER][NEUTRAL] OK, no, OK.
[CUSTOMER][NEUTRAL] OK, and then when we submit claims, are we sending them to APL or 90 Degrees or the.
[AGENT][NEUTRAL] You, you should see an [PII] address on that ID card.
[CUSTOMER][NEUTRAL] Um,
[CUSTOMER][NEUTRAL] Um, let's see, it does say [PII].
[AGENT][NEUTRAL] That's it.
[CUSTOMER][NEUTRAL] Um, [PII], but do we address the claims to 90 Degrees or to who's the, who do we address it to like what name of the company, I guess.
[AGENT][NEUTRAL] That is where you saying you're going to.
[AGENT][NEUTRAL] No, address it at American Public Life APL, but send it to that [PII], yes ma'am.
[CUSTOMER][NEUTRAL] To
[CUSTOMER][NEUTRAL] American, OK, APL is who.
[CUSTOMER][NEUTRAL] OK, thank you, Miss [PII]. Can I just get a call reference number for our call today?
[AGENT][NEUTRAL] Well.
[AGENT][NEUTRAL] Well, we don't give call reference numbers, but you can use my name on today's date, and of course my name is [PII], OK?
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][POSITIVE] OK, well thank you so much [PII].
[AGENT][NEUTRAL] Well, yes, ma'am. [PII], now, is that all I can answer for you today?
[CUSTOMER][POSITIVE] Yes ma'am, that is. Thank you so much for your help.
[AGENT][POSITIVE] OK. Well, thank you so much. Yes, ma'am, and thanks for calling IPM [PII]. You have a great rest of your day.
[CUSTOMER][POSITIVE] You too, thank you, ma'am. Alright, bye bye.
[AGENT][POSITIVE] Thank you, ma'am. Bye bye.