AccountId: 011433970860
ContactId: 9cbb4e6b-5071-481a-b0d9-da98a1b09f7d
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 330640 ms
Total Talk Time (AGENT): 145971 ms
Total Talk Time (CUSTOMER): 94162 ms
Interruptions: 2
Overall Sentiment: AGENT=0.6, CUSTOMER=0.3
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/04/09/9cbb4e6b-5071-481a-b0d9-da98a1b09f7d_20250409T20:53_UTC.wav
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[AGENT][NEUTRAL] Thank you for calling APL. This is [PII]. How can I help you?
[CUSTOMER][NEUTRAL] Hi [PII], my name's [PII] and I'm calling from Sigma Primary Care. I'm trying to get benefits and eligibility for a patient. Would you be able to help me?
[AGENT][NEUTRAL] Mhm.
[AGENT][NEUTRAL] OK, [PII], right, you need eligibility and benefits, correct?
[CUSTOMER][NEUTRAL] Yes.
[AGENT][POSITIVE] Well, yes, [PII], I can help you with those things. And what is a good call back number for you please?
[CUSTOMER][NEUTRAL] [PII].
[AGENT][POSITIVE] Thank you and the member's policy number, please.
[CUSTOMER][NEUTRAL] The policy number that I have is 02563333.
[CUSTOMER][NEUTRAL] We
[AGENT][NEUTRAL] OK, thank you one moment while I get the member's information.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Uh,
[CUSTOMER][NEUTRAL] You
[AGENT][NEUTRAL] OK, and [PII], any information that I do provide for you today will be a verification of benefits and not guarantee of payment. What is your patient's name please and their date of birth?
[CUSTOMER][NEUTRAL] Her name is [PII]. How do you pronounce the last name? [PII]
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] And then um date of birth is [PII].
[AGENT][POSITIVE] OK, thank you.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] [PII], OK.
[AGENT][NEUTRAL] OK, so I do show that she is the subscriber on this limited benefit plan. This policy is active aerial with an effective date of [PII].
[CUSTOMER][NEUTRAL] To make sure you
[AGENT][NEUTRAL] And what type of benefit information do you need for her today? inpatient, outpatient or office?
[CUSTOMER][NEUTRAL] Um,
[CUSTOMER][NEUTRAL] It's for office.
[AGENT][NEUTRAL] For an office visit?
[CUSTOMER][NEUTRAL] Yes, it's primary care mhm.
[AGENT][NEUTRAL] OK, so on this on this limited benefit plan for outpatient accident and sickness treatment, a phys the physician's office benefit is $50 per day.
[AGENT][NEUTRAL] And a maximum of 4 days per calendar year per covered person.
[CUSTOMER][NEUTRAL] OK. And is Doctor um [PII] in network with this policy? Are you able to tell me that?
[AGENT][NEUTRAL] Now, for this plan, this plan participates with the multi-plan network.
[CUSTOMER][NEUTRAL] Mhm mhm.
[AGENT][NEUTRAL] And I can provide you their phone number if you do not know if he is a multi-plan provider.
[AGENT][NEUTRAL] I can also connect you with them, but OK, but this is a, yes, this plan participates in the multi-plan network.
[CUSTOMER][NEUTRAL] Mhm. Uh, he is.
[CUSTOMER][NEUTRAL] No, so
[CUSTOMER][NEUTRAL] OK, so does she have a copay today for office?
[AGENT][NEUTRAL] Again, this is not major medical insurance. It's a limited benefit plan, so it pays specific amounts for certain services. So the benefit amount on this plan again is $50 per day, maximum of 4 days per calendar year. There is no co-pay.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEGATIVE] No co-pay.
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] And then is there, does a primary care physician have to be assigned to this policy?
[AGENT][NEGATIVE] No, it does not.
[AGENT][NEUTRAL] No.
[CUSTOMER][NEUTRAL] No? OK.
[CUSTOMER][NEUTRAL] So 0 copay, no assignment. Can I have a reference number?
[AGENT][NEUTRAL] No no.
[AGENT][NEUTRAL] Yes, ma'am, you would use my name that I gave you along with today's date.
[AGENT][NEUTRAL] And then once the claim has been processed through, you all should be able to check the claim status by going to our portal which is located at [PII].
[CUSTOMER][NEUTRAL] OK, it
[CUSTOMER][NEUTRAL] And do you have a reference number for this call? I'm sorry.
[AGENT][NEUTRAL] Yes, ma'am, you would use my name along with today's date.
[CUSTOMER][NEUTRAL] What's your name? I'm sorry, can you spell it?
[AGENT][NEUTRAL] [PII]
[CUSTOMER][NEUTRAL] And in today's date is [PII] OK.
[AGENT][NEUTRAL] Yes, ma'am. Uh-huh.
[AGENT][NEUTRAL] OK.
[CUSTOMER][POSITIVE] All right, thank you so much.
[AGENT][POSITIVE] Well, you're welcome. So again, if that is all I can help you with, thank you for calling APO and I hope you have a very nice rest of your day.
[CUSTOMER][POSITIVE] Yeah thanks bye.
[AGENT][NEUTRAL] Um bye bye.