AccountId: 011433970860
ContactId: b010f547-df66-473f-994b-6d1bf81ee636
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 211360 ms
Total Talk Time (AGENT): 106892 ms
Total Talk Time (CUSTOMER): 69781 ms
Interruptions: 0
Overall Sentiment: AGENT=1.1, CUSTOMER=0.9
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/02/21/b010f547-df66-473f-994b-6d1bf81ee636_20250221T15:53_UTC.wav
--------------------------------------------
[AGENT][NEUTRAL] Thank you for calling APL. This is [PII]. How can I help you?
[CUSTOMER][NEUTRAL] Hi, my name is [PII]. I'm calling from Providence Saint Mary's High Desert Medical Group. I'm actually calling to find eligibility and benefits for a patient.
[AGENT][POSITIVE] Yeah, I can check eligibility and benefits for you. Um, [PII], can I get a good call back number from you first in case we're disconnected?
[CUSTOMER][NEUTRAL] Yeah, [PII].
[AGENT][NEUTRAL] OK, thank you and then do you have the policy number?
[CUSTOMER][NEUTRAL] Uh, policy, yes, it's 02584980.
[AGENT][NEUTRAL] OK thank you one moment.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Yeah
[AGENT][NEUTRAL] OK, and now what was the name and date of birth for the insured?
[CUSTOMER][NEUTRAL] Um, it's uh [PII]. I can't even, um, it's [PII] and then the last name is [PII]
[AGENT][NEUTRAL] Got it.
[CUSTOMER][NEUTRAL] And date of date of birth is [PII].
[AGENT][NEUTRAL] OK, thank you for verifying all of that. [PII], so this policy is active. Effective date was [PII].
[CUSTOMER][POSITIVE] Thank you.
[AGENT][NEUTRAL] And this is a limited indemnity medical plan, so if you'll give me one moment, let me get that policy pulled up, um, what, uh, kind of benefits will be needing to check?
[CUSTOMER][NEUTRAL] It's just for like an office visit, PCP.
[AGENT][NEUTRAL] OK, give me just a moment, let me make sure that that is going to be a covered benefit under this policy.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] OK, of course I will let you know verification of coverage is not a guarantee of payment for claims does not look like they have office visit benefits.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][POSITIVE] They have benefits for.
[AGENT][NEUTRAL] Diagnostic testing, um, and then hospital consignment, admission, and surgical benefits. That seems to be the extent of this policy.
[CUSTOMER][NEUTRAL] OK. Do they have like benefits for established care, new patient?
[AGENT][NEGATIVE] No, nothing like that that doesn't appear to be any sort of wellness benefits.
[CUSTOMER][NEUTRAL] Oh, so it's technically just the ER visits?
[AGENT][NEUTRAL] Um, hospital, um, and then surgical diagnostic testing benefits, that's going to be it for this policy.
[CUSTOMER][NEUTRAL] Oh, OK, so no, uh, PCP offices is any of that.
[AGENT][NEUTRAL] No office visits, right.
[CUSTOMER][NEUTRAL] Oh wow. OK. So how would this patient get care if he needs like a physical or anything like that?
[AGENT][NEUTRAL] I would see if uh they have additional coverage elsewhere um again this is a limited indemnity plan so I don't know if they might have other uh kinds of policies through different carriers.
[CUSTOMER][NEUTRAL] OK, I'll talk to the patient and then let him know if he has any other type of insurance.
[AGENT][NEUTRAL] Sure, was there anything else I can help you with, [PII]?
[CUSTOMER][NEUTRAL] OK
[CUSTOMER][NEUTRAL] No, that's about it.
[AGENT][POSITIVE] Alright, well thanks for calling APL. I hope you have a great day.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Yeah, 11 2nd, what do you have a confirmation number for this call?
[AGENT][NEUTRAL] Sure.
[AGENT][NEUTRAL] Oh, it would just be my first name, last initial and today's date. Uh so my name is spelled [PII]
[CUSTOMER][POSITIVE] OK, thank you so much for your help.
[AGENT][POSITIVE] Of course, thanks for calling EPO. Have a great rest of your day.
[CUSTOMER][POSITIVE] You too thank you bye bye.
[AGENT][POSITIVE] Thank you. Bye bye.