AccountId: 011433970860
ContactId: 9e143c1c-f75e-4421-81ac-e0ff722dae87
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 282350 ms
Total Talk Time (AGENT): 139367 ms
Total Talk Time (CUSTOMER): 129359 ms
Interruptions: 3
Overall Sentiment: AGENT=1.7, CUSTOMER=0.8
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/01/16/9e143c1c-f75e-4421-81ac-e0ff722dae87_20250116T13:03_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], this is [PII] with Reed Orthopedic Center. I am calling to verify insurance coverage on um a patient in our office today.
[AGENT][NEUTRAL] OK, [PII], you're needing to verify eligibility and benefits or just eligibility?
[CUSTOMER][NEUTRAL] Just eligibility please.
[AGENT][POSITIVE] Yes, ma'am, I can help you with that. And [PII], first off, what is a good callback number for you, please?
[CUSTOMER][NEUTRAL] Um, it would be [PII].
[AGENT][POSITIVE] Thank you.
[CUSTOMER][NEUTRAL] It says it's.
[AGENT][NEUTRAL] And what is the patient's policy number, please?
[CUSTOMER][NEUTRAL] The policy number is 02567206.
[AGENT][POSITIVE] OK, one moment, please. Thank you.
[CUSTOMER][NEUTRAL] Bye
[CUSTOMER][POSITIVE] That's correct.
[CUSTOMER][NEUTRAL] Well the other day when I finally got it back he was like.
[CUSTOMER][NEUTRAL] coverage
[CUSTOMER][NEUTRAL] OK, so I am going to.
[CUSTOMER][NEUTRAL] But like I said, if you get a bill and you.
[AGENT][NEUTRAL] OK, and any information here that I do provide for you will be a verification of benefits and not a guarantee of payment. What is your patient's name and their date of birth?
[CUSTOMER][NEUTRAL] Um, patient's name is [PII]. Date of birth [PII].
[AGENT][POSITIVE] OK, thank you.
[CUSTOMER][POSITIVE] That sounds fair.
[AGENT][NEUTRAL] So I do show that she is the spouse of the subscriber on this policy and this policy is active. The effective date on it is [PII].
[CUSTOMER][NEUTRAL] Mhm
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Like
[AGENT][NEUTRAL] And then [PII], once we have processed the claim, you should be able to access our explanation of benefits by going to [PII].
[CUSTOMER][POSITIVE] OK, secured. [PII].
[AGENT][NEUTRAL] Uh-huh, [PII].
[CUSTOMER][NEUTRAL] As in Mary
[AGENT][NEUTRAL] Uh-huh.
[CUSTOMER][NEUTRAL] Uh, so, say that say that 3rd.
[AGENT][NEUTRAL] OK, I'm gonna, I'll just repeat it all one more time, secured.
[CUSTOMER][NEUTRAL] The yeah.
[AGENT][NEUTRAL] [PII]
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][POSITIVE] [PII].
[AGENT][NEUTRAL] [PII].
[CUSTOMER][NEUTRAL] [PII]. OK, thank you, got it.
[AGENT][NEUTRAL] Mhm.
[AGENT][POSITIVE] Yes, ma'am. You are very welcome. And is there anything else, [PII], that I can help you with this morning?
[CUSTOMER][NEUTRAL] Um, yes, ma'am, if you would, could you, can you tell me if there are any co-pays or can you just verify eligibility at this point?
[CUSTOMER][NEUTRAL] you
[AGENT][NEUTRAL] OK, so you do need benefit information?
[CUSTOMER][NEUTRAL] Um, I, I guess if it's a different one than I do, yes.
[AGENT][NEUTRAL] OK, you say a different one. I'm sorry. What, what do you mean by that?
[CUSTOMER][NEUTRAL] Well,
[CUSTOMER][NEUTRAL] OK, so.
[CUSTOMER][NEUTRAL] You verify coverage.
[AGENT][NEUTRAL] The eligibility. Uh-huh, is that.
[CUSTOMER][NEUTRAL] Eligibility and then so co-pays would be benefits is that what you're saying?
[AGENT][NEUTRAL] Yes, this policy is not a major medical plan. It is a hospital indemnity limited benefit plan.
[CUSTOMER][NEUTRAL] OK
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] And what type of benefit information are you needing? inpatient, outpatient or office?
[CUSTOMER][NEUTRAL] We are a specialty office, the orthopedic mhm.
[AGENT][NEUTRAL] OK. So for outpatient, OK, outpatient accident and sickness.
[AGENT][NEUTRAL] Benefits for an office visit is $50 per day, with a maximum of 4 days per calendar year per covered person.
[CUSTOMER][NEUTRAL] I
[CUSTOMER][NEUTRAL] So a max of 4 days per year.
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] OK, um, so this would be considered what you said outpatient?
[AGENT][POSITIVE] Yes, ma'am. Well that for an office visit, that is the benefit.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][POSITIVE] OK, so $50 per day with a maximum of 4 days per year for this coverage. OK, very good. All right, and that's, um, alright, I appreciate that and um.
[AGENT][POSITIVE] That is correct. Yes, ma'am. Uh-huh. Yes, ma'am.
[CUSTOMER][NEUTRAL] I've got your name as [PII]. Is there a reference number?
[AGENT][NEUTRAL] You would use my name along with today's date.
[CUSTOMER][POSITIVE] All right thank you so much ma'am you have a wonderful day.
[AGENT][POSITIVE] Well, well, I hope you have a very nice day as well, and that's all I can help you with, [PII]. Thank you again for calling APL.
[CUSTOMER][POSITIVE] Yes thank you bye bye.
[AGENT][NEUTRAL] Uh-huh. Bye-bye.