AccountId: 011433970860
ContactId: a13dc850-f1ee-4b6f-8acb-afd5c0900d8a
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 291359 ms
Total Talk Time (AGENT): 109961 ms
Total Talk Time (CUSTOMER): 111442 ms
Interruptions: 0
Overall Sentiment: AGENT=1.3, CUSTOMER=0.3
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/04/03/a13dc850-f1ee-4b6f-8acb-afd5c0900d8a_20250403T20:05_UTC.wav
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[AGENT][POSITIVE] Thanks for calling APL. This is [PII]. How can I help you?
[CUSTOMER][NEUTRAL] Hi, [PII]. My name is [PII] calling from the doctor's office. I was wondering if I could get benefits on a patient, please.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] OK, did you say [PII], is that correct?
[CUSTOMER][NEUTRAL] I did, and your name was [PII]?
[AGENT][NEUTRAL] OK.
[AGENT][POSITIVE] Yes, that's correct. OK, [PII], I can help you with benefits. Um, do you have a good callback number?
[CUSTOMER][POSITIVE] Thank you.
[CUSTOMER][NEUTRAL] I do. [PII] and that's a direct line to me.
[AGENT][NEUTRAL] OK, thank you. And do you have a policy number of the patient?
[CUSTOMER][NEUTRAL] I do. It is let me go back over here.
[CUSTOMER][NEUTRAL] Um,
[CUSTOMER][NEUTRAL] And I just closed it down. Let me see if I can get my glasses on. I'm sorry. It's um 02610679.
[AGENT][POSITIVE] Oh, no worries.
[AGENT][POSITIVE] OK, thank you.
[AGENT][NEUTRAL] And the patient name and date of birth?
[CUSTOMER][NEUTRAL] Patient's name is [PII], [PII].
[AGENT][POSITIVE] OK, thank you.
[AGENT][NEUTRAL] And you said you needed benefits, is that correct?
[CUSTOMER][NEUTRAL] Yes, ma'am.
[AGENT][NEUTRAL] OK, uh, I've got him active and effective [PII]. This is not a guarantee of payment basic outline of the policy. Let's see what he has here. Is this gonna be for like outpatient visit or?
[CUSTOMER][NEUTRAL] Well, we're multi-specialty, so we're, uh, I needed like an office visit at [PII], um.
[CUSTOMER][NEUTRAL] A [PII] and then we're chiropractic and physical therapy also.
[AGENT][NEUTRAL] Let me see what he's got.
[CUSTOMER][NEUTRAL] The PC logos on the back of the card.
[CUSTOMER][NEUTRAL] Multiplan. This is a limited, isn't it?
[AGENT][NEUTRAL] It is, it's a hospital indemnity plan.
[AGENT][NEUTRAL] Um, so let me see what benefits are under this.
[AGENT][NEUTRAL] Um,
[CUSTOMER][NEUTRAL] And it's a multi-plan limited package.
[AGENT][NEUTRAL] So let's see, he's got.
[AGENT][NEUTRAL] I'm trying to pull up the policy certificate. Let me see.
[CUSTOMER][NEUTRAL] I would be uh if you wanna be over there or here.
[CUSTOMER][NEUTRAL] A.
[AGENT][NEUTRAL] OK, here we go, physician's office.
[AGENT][NEUTRAL] OK, so for uh physician's office, he has, it'll pay out a maximum of $50.04 times per year.
[AGENT][NEUTRAL] Um, physical therapy.
[CUSTOMER][NEUTRAL] Pay out maximum, uh, I'm sorry, I didn't write fast enough. Pay out a maximum of $50 per visit for, for, per year.
[AGENT][POSITIVE] Yes, that's correct. Um, let's see, for physical therapy.
[AGENT][NEUTRAL] He's got a max payout of $30 that will pay out 4 times per year.
[AGENT][NEUTRAL] Um, let's.
[CUSTOMER][NEUTRAL] $30.04 times a year. So that's for 4 visits, right?
[AGENT][POSITIVE] Correct.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] Uh, I don't see any chiropractic benefits.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEGATIVE] No benefits.
[AGENT][NEUTRAL] No, no, yeah.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Is there a deductible, or do you just pay that amount and then um he's responsible for the rest?
[AGENT][NEUTRAL] No.
[AGENT][NEUTRAL] Yes, so we don't determine patient responsibility, but yes, that the policy works that it pays a certain dollar amount and those are the ones that I just quoted, so.
[CUSTOMER][NEUTRAL] Does it pay to the patient or pay to the provider?
[AGENT][NEUTRAL] It depends on how the claim is filed. If you file the claim with the assignment of benefits, we'll pay you if the insured uh client files it, then we pay the insured.
[CUSTOMER][NEUTRAL] OK
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][POSITIVE] Thank you so much. OK, so, uh, some of the benefits pay us.
[AGENT][NEUTRAL] OK, is there anything else
[AGENT][NEUTRAL] What
[CUSTOMER][NEUTRAL] Um,
[CUSTOMER][NEUTRAL] OK, so they're gonna only pay $50 for 4 ENM $30.04 times a year and no yer benefits. OK, thanks so much. That's all I needed. Can I just get a reference number, please?
[AGENT][NEUTRAL] Um, it's just my first name, first initial, last name, so it's [PII] and then today's date.
[CUSTOMER][POSITIVE] All right. Thanks so much. Have a great day.
[AGENT][POSITIVE] OK, thanks for calling APL you as well.