AccountId: 011433970860
ContactId: a48affbe-7c9f-4f19-938a-a06129144f87
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 282500 ms
Total Talk Time (AGENT): 139293 ms
Total Talk Time (CUSTOMER): 131157 ms
Interruptions: 3
Overall Sentiment: AGENT=1.1, CUSTOMER=0.5
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/02/18/a48affbe-7c9f-4f19-938a-a06129144f87_20250218T22:51_UTC.wav
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[AGENT][NEUTRAL] Good afternoon. Thank you for calling APL. This is [PII]. How may I assist you?
[CUSTOMER][NEUTRAL] Hi, my name is [PII]. I'm calling from Portland Avis Medical Center in [PII], and I'm just calling uh on eligibility of a patient.
[AGENT][NEUTRAL] OK, sure. I can assist you with eligibility, Ms. [PII]. May I have a callback number just in case we get disconnected?
[CUSTOMER][NEUTRAL] Yes, [PII].
[AGENT][NEUTRAL] Thank you. And may I have the patient's policy number?
[CUSTOMER][NEUTRAL] Policy number is 02586149.
[AGENT][NEUTRAL] May I have the name and date of birth of the patients coming?
[CUSTOMER][NEUTRAL] Yes, it's [PII] Date of birth is [PII].
[AGENT][NEUTRAL] Perfect. Thank you. All right. And you say you need eligibility. We have an effective date of [PII]. It is active at the moment and this is one of our limited hospital indemnity plan.
[CUSTOMER][NEUTRAL] OK, um, and first off, uh, what network are you under? What network do you use?
[AGENT][NEUTRAL] If the provider participates with a multi-plan, they get that additional discount, but it is not required.
[CUSTOMER][NEUTRAL] OK, multi plan?
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] OK. And then, um, do you, can you give me the co-pays for like office visit and specialty and urgent care?
[AGENT][NEUTRAL] OK, this one doesn't have any co-payments, co-insurance, or deductibles. This one pays a flat amount, OK? So let me go ahead and give you that amount, and this is not a guarantee of payment, just a verification of coverage, and that's just a disclaimer. And for an office visit, we cover $50 and that's maximum of 4 visits per covered person per calendar year for an urgent care, it's the same thing. Mhm. OK. Mhm.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK, just a minute, just OK, just wait just a second, Max, OK, $50 max 4 visits per calendar year.
[AGENT][POSITIVE] Correct.
[CUSTOMER][NEUTRAL] OK. And is that a sick visit or do you distinguish between sick visit or well visit for the office?
[AGENT][NEUTRAL] OK, um, for that one it's gonna be sickness or accident.
[CUSTOMER][NEUTRAL] This one that you just gave me is for sickness, OK.
[AGENT][POSITIVE] Mhm. Correct.
[CUSTOMER][NEUTRAL] OK. Do you have a different one for uh well office visit, like a physical or checkup or anything?
[AGENT][NEUTRAL] OK, with this policy we do not cover preventative.
[CUSTOMER][NEUTRAL] OK, OK.
[AGENT][NEUTRAL] Um, yeah, preventatives are usually covered with another, um, which is, um,
[AGENT][NEUTRAL] I
[CUSTOMER][NEUTRAL] OK. And then, yeah.
[AGENT][NEUTRAL] I'm not sure if that one is listed, but yeah, that's the one that covers preventative. Mhm.
[CUSTOMER][NEUTRAL] OK, for specialty?
[AGENT][NEUTRAL] OK, it's gonna be the same one. The physician's office visit is either for the physician or a specialist.
[CUSTOMER][NEUTRAL] OK, so the 4 visit, is that combined like those two is that 4 visits, so combined.
[AGENT][NEUTRAL] Combined. Mhm. Yes, yes.
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] And then what about urgent care?
[AGENT][NEUTRAL] OK, the urgent care is also $50 but that's a separate benefit and that's another 4 visits.
[AGENT][NEUTRAL] An additional 4 visits. Mhm.
[CUSTOMER][NEUTRAL] Yeah, OK.
[CUSTOMER][NEUTRAL] And let's see, do I need to, so for claims, um, on the card it said send claims to [PII], is that correct?
[AGENT][NEUTRAL] Mhm
[AGENT][NEUTRAL] Mhm.
[AGENT][POSITIVE] That is correct, yes.
[CUSTOMER][NEUTRAL] OK, OK, I think that's what I need and the medical ID number, that's not something then the policy number is the one that's the like member number or whatever, is that right?
[AGENT][NEUTRAL] Um, yeah, you can use either or um for IMA like if there's any preventative service, I would use that ID number starts with a D because that's the preventative one that that will be preventative. Um, and then if it's just medical sickness or accident, that will be our number, which is the policy certificate number or ID number. Mhm.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] So the medical ID is the IMA number.
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] And the other one is the APL number.
[AGENT][POSITIVE] Mhm. Great.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][POSITIVE] OK, I think I have it. Thank you so much for your help.
[AGENT][NEUTRAL] Mhm
[AGENT][NEUTRAL] You're welcome. Is there anything else I'm gonna help you with today, Ms. [PII]?
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][POSITIVE] That's it. Thank you so much.
[AGENT][POSITIVE] OK. You're welcome and thank you for calling APL. Have a good afternoon. Bye-bye.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][POSITIVE] Uh-huh. Thanks, bye bye.
[AGENT][POSITIVE] You're welcome.