AccountId: 011433970860
ContactId: afda5d1c-df17-4cd4-bf0d-d6f41bd9f8ec
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 277649 ms
Total Talk Time (AGENT): 78320 ms
Total Talk Time (CUSTOMER): 133905 ms
Interruptions: 2
Overall Sentiment: AGENT=2.1, CUSTOMER=0.2
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/05/13/afda5d1c-df17-4cd4-bf0d-d6f41bd9f8ec_20250513T19:46_UTC.wav
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[AGENT][POSITIVE] Thank you for calling APL. my name is [PII]. How can I assist you today?
[CUSTOMER][NEUTRAL] Uh, [PII], my name's [PII]. I'm with Rochell Community Hospital. Um, we have a member that needs to have, um, an office visit, but when the nurse called, she said that it was an indemnity plan.
[AGENT][NEUTRAL] Um
[CUSTOMER][NEUTRAL] Um, so I need to get a little bit more information on that if you don't mind.
[AGENT][POSITIVE] OK, I'd be happy to assist with benefits and eligibility today, [PII], if I can get a good call back number for you.
[CUSTOMER][NEUTRAL] It is [PII].
[AGENT][NEUTRAL] And what is the policy number?
[CUSTOMER][NEUTRAL] Well I have.
[CUSTOMER][NEUTRAL] Uh sorry.
[CUSTOMER][NEUTRAL] I have 02514692.
[AGENT][NEUTRAL] Patient's name and date of birth.
[CUSTOMER][NEUTRAL] This is [PII] [PII].
[AGENT][NEUTRAL] Thank you for that information. Please be advised the verification of coverage is not a guarantee of payment. I do show the policy is currently active. Effective date is [PII], and this is a limited benefit hospital indemnity plan and for office visits she has 4 visits per calendar year with the benefit amount of $100 per visit.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] OK, so 4 office visits per year.
[AGENT][POSITIVE] Correct.
[CUSTOMER][NEUTRAL] $100 each visit.
[AGENT][POSITIVE] That's correct.
[CUSTOMER][NEUTRAL] And can you tell if she's had the 4 yet?
[AGENT][NEUTRAL] No, she's only had one.
[CUSTOMER][NEUTRAL] And then what about um?
[CUSTOMER][NEUTRAL] X-rays or labs or anything like that.
[AGENT][NEUTRAL] All treatment that's done at the visit is included in that $100. That's just it's still considered an office visit.
[CUSTOMER][NEUTRAL] OK. Now, what about any surgery?
[AGENT][NEUTRAL] Um, now, for surgical procedures,
[CUSTOMER][NEUTRAL] I think they said she broke something and may need surgery.
[AGENT][NEUTRAL] Um, surgery in a facility is a $1000 benefit. Surgery in an office visit is $250.
[CUSTOMER][NEUTRAL] So surgery at facility, you cover 1000 only.
[AGENT][POSITIVE] Correct.
[CUSTOMER][NEUTRAL] Is that correct?
[AGENT][POSITIVE] Correct.
[CUSTOMER][NEUTRAL] And do you have a limit on the number of surgeries she has in a calendar year?
[AGENT][NEUTRAL] In a facility 1 in an office visit 2.
[CUSTOMER][NEUTRAL] Surgery facility 1000.
[CUSTOMER][NEUTRAL] Only and one per year.
[CUSTOMER][NEUTRAL] In the office you allowed how many?
[AGENT][NEUTRAL] 2.
[CUSTOMER][NEUTRAL] And what was the total that was paid on that?
[AGENT][NEUTRAL] For office visits $250.
[CUSTOMER][NEUTRAL] OK, I just wanna recap because I was writing and so she's only had one office visit so far this year. She's allowed 4 and you will pay $100 for each visit only, and that would include any X-rays or labs or anything that she had.
[AGENT][POSITIVE] That's correct.
[CUSTOMER][NEUTRAL] If she has a surgery in office, she gets 2 a year and you'll only cover $250 and if she has surgery at a facility you will pay for $1000 only and that's 1 a year and she has not had any yet so far this year, is that correct?
[AGENT][POSITIVE] Correct.
[AGENT][NEUTRAL] No.
[CUSTOMER][NEUTRAL] None this year.
[CUSTOMER][NEUTRAL] What about the in office?
[AGENT][NEUTRAL] Only one.
[AGENT][NEUTRAL] Oh, you mean the surgery? Oh no, she has no surgeries. No, none of that. She hasn't used any of the surgeries.
[CUSTOMER][NEUTRAL] So she has had
[CUSTOMER][NEUTRAL] This, yeah. OK.
[AGENT][NEUTRAL] Just one regular visit.
[CUSTOMER][NEUTRAL] In office surgery.
[CUSTOMER][NEUTRAL] None this year.
[CUSTOMER][NEUTRAL] OK, and [PII], do you have a um reference number for the call?
[AGENT][NEUTRAL] Reference is just my name and today's date and time. Was there anything else I can assist with today?
[CUSTOMER][POSITIVE] No, I think I've got it. Thanks. Have a great day.
[AGENT][POSITIVE] Thanks for calling APL have a good day.