AccountId: 011433970860
ContactId: ad2ca631-ac0f-444d-ab2a-310f5e541d61
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 309619 ms
Total Talk Time (AGENT): 146865 ms
Total Talk Time (CUSTOMER): 111338 ms
Interruptions: 4
Overall Sentiment: AGENT=1.1, CUSTOMER=0.7
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/03/12/ad2ca631-ac0f-444d-ab2a-310f5e541d61_20250312T13:16_UTC.wav
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[AGENT][POSITIVE] Good morning. Thank you for calling APO. This is [PII]. How can I help you?
[CUSTOMER][NEUTRAL] Uh, yes, I was just calling to check, um, eligibility on a patient's insurance.
[CUSTOMER][NEUTRAL] Calling with, uh, Texas Health Family Care.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] So you're needing eligibility and benefits also on a dental policy?
[CUSTOMER][NEUTRAL] Yes.
[CUSTOMER][NEUTRAL] It's not a dental, it's a group hospital indemnity.
[AGENT][NEUTRAL] Oh, I'm sorry. I thought you said dental. OK, yes ma'am, I can help you with that. And what is your callback? I'm sorry, first off, who am I speaking with?
[CUSTOMER][NEUTRAL] Hm
[CUSTOMER][NEUTRAL] My name is [PII].
[AGENT][NEUTRAL] I'm sorry, say your name one more time.
[CUSTOMER][NEUTRAL] [PII]
[AGENT][NEUTRAL] Hey, [PII]. Thank you. And your callback number, please?
[CUSTOMER][NEUTRAL] Sure, it's [PII].
[AGENT][NEUTRAL] OK, thank you. And again, you're needing benefits and eligibility or only eligibility?
[CUSTOMER][POSITIVE] Both, please, thank you.
[AGENT][NEUTRAL] Yes ma'am, I can help you. And what is the member's policy number please, Say?
[CUSTOMER][NEUTRAL] Yes, it's 1002371.
[AGENT][POSITIVE] OK, thank you one moment.
[CUSTOMER][NEUTRAL] And what is your name again? I'm sorry?
[AGENT][NEUTRAL] [PII]
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] Uh
[CUSTOMER][POSITIVE] Good morning
[AGENT][NEUTRAL] OK Pay, any information that I do provide for you today would be a verification of benefits and not a guarantee of payment. What is your patient's name, please, and their date of birth?
[CUSTOMER][NEUTRAL] Yes, it's for [PII], uh, date of birth. Hold, let me go back in here.
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] That would be [PII].
[CUSTOMER][NEUTRAL] [PII].
[AGENT][POSITIVE] OK, thank you.
[AGENT][NEUTRAL] So I do show she is the subscriber on this limited benefit plan and it is active with an effective date of [PII]. I'm sorry, that's her birthday. I'm so sorry.
[AGENT][NEUTRAL] This policy is active effective [PII], and what type of benefit information do you need on this plan inpatient, outpatient or office?
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] And there's the policy holder on your insurance.
[CUSTOMER][NEUTRAL] Uh, in office.
[AGENT][NEUTRAL] OK, one moment.
[CUSTOMER][NEUTRAL] Oh.
[AGENT][NEUTRAL] OK, so on this limited benefit plan for outpatient sickness, the benefit is $50 per visit and a maximum of 5 visits per calendar year.
[CUSTOMER][NEUTRAL] And.
[CUSTOMER][NEUTRAL] So it covers the co-pay I'm assuming for her primary.
[AGENT][NEUTRAL] Uh, this is a limited benefit plan. It is not a supple, I mean, it's a just a hospital indemnity limited benefit plan. So this
[CUSTOMER][NEUTRAL] This is in regards to your physical. You'll read it over. You'll make one of these two selections you'll give this one to the medical um.
[AGENT][NEUTRAL] Benefit on this specific policy would be $50 per visit and a maximum of 4 excuse me, 5 visits per calendar year. I'm having trouble getting my information out to you, [PII]. I'm sorry.
[CUSTOMER][NEUTRAL] OK, because the patient does have a, a primary, so she has a $30 I guess it just takes care of that. I'm assuming well because it's $50 right?
[AGENT][NEUTRAL] The benefit on this policy is $50.
[CUSTOMER][NEUTRAL] see
[CUSTOMER][POSITIVE] OK, sounds good thank you alright.
[AGENT][NEUTRAL] You're certainly welcome then [PII], if you all do file a claim with APL, once the claim has been processed, we do have a portal that you should be able to check claim status in, and the portal website for that is [PII].
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] Well
[CUSTOMER][NEUTRAL] tomorrow.
[CUSTOMER][NEUTRAL] OK, what is, um, do you have a reference number for this call?
[AGENT][NEUTRAL] Yes, ma'am, you would use my name along with today's date.
[CUSTOMER][NEUTRAL] OK, uh, [PII], you have what's the initial to your last name?
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] [PII].
[CUSTOMER][NEUTRAL] It's uh [PII], sorry.
[AGENT][POSITIVE] All right. Well, again, Ay, yes, ma'am, you're welcome. So if I, that's all I can help you with this morning, thank you again for calling APL and I hope you have a great day.
[CUSTOMER][POSITIVE] OK, alright, thank you.
[CUSTOMER][NEUTRAL] Hm
[CUSTOMER][POSITIVE] You too thank you bye bye.
[AGENT][POSITIVE] Thank you, bye bye.