AccountId: 011433970860
ContactId: b7d6246a-996f-429d-9708-02b0c5f09e5b
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 379299 ms
Total Talk Time (AGENT): 166928 ms
Total Talk Time (CUSTOMER): 136786 ms
Interruptions: 1
Overall Sentiment: AGENT=0.1, CUSTOMER=0.6
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/05/29/b7d6246a-996f-429d-9708-02b0c5f09e5b_20250529T22:02_UTC.wav
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[AGENT][NEUTRAL] Thank you for calling APL. This is [PII]. How can I help you?
[CUSTOMER][NEUTRAL] Hello there. I'm just trying to verify that patient's insurance is in our network and then um if so the effective date of coverage when it started please.
[AGENT][NEUTRAL] OK, I can help you with eligibility. um can I get your name and a good call back number in case we get disconnected?
[CUSTOMER][NEUTRAL] Sure it's [PII].
[CUSTOMER][NEUTRAL] [PII]
[AGENT][NEUTRAL] And do you have the patient's policy number, Juliet?
[CUSTOMER][NEUTRAL] I do. It is 025-71787.
[AGENT][NEUTRAL] OK, one moment.
[CUSTOMER][POSITIVE] Thank you.
[AGENT][NEUTRAL] Can I get you to verify the patient's name and date of birth?
[CUSTOMER][NEUTRAL] Uh yeah, [PII] [PII].
[AGENT][POSITIVE] Thank you so much.
[CUSTOMER][POSITIVE] Thank you.
[AGENT][NEUTRAL] I'm showing that this policy is active with an effective date of [PII]. This is a hospital indemnity plan. Uh, so we don't go through networks. We go through, uh, we just give benefit amounts based off of the procedures being done. Uh, if you like, if you would like, I can look up some of those benefits for you, um, but we don't go based off of network.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK, so.
[CUSTOMER][NEUTRAL] I'm just writing this down for my note.
[CUSTOMER][NEUTRAL] All right, not based on network, so you go by procedure.
[AGENT][NEUTRAL] Yes, ma'am. And we pay an allotted amount per procedure for that.
[CUSTOMER][NEUTRAL] Procedure
[CUSTOMER][NEUTRAL] OK, all right, so this patient um is coming in to see a primary care doctor.
[CUSTOMER][NEUTRAL] For office visit.
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] And I would not have a code for that. I don't, I don't have that information.
[AGENT][NEUTRAL] Um, let me see if they have an office visit writer cause it's not looking, this is a hospital indemnity plan, so office visits. Um, I would have to check on that.
[CUSTOMER][NEUTRAL] So basically patient can go wherever she wants if you just pay the amount depending on the procedure code.
[AGENT][NEUTRAL] Yes, so, um, and this is just a verification of benefits, not a guarantee of payment. So, um, say she goes to get.
[AGENT][NEUTRAL] Um, go into the hospital. She has a a hospital admission benefit of up to $1000 per day. Uh, we also have I an ICU benefit, rehab, a rehabilitation benefit.
[AGENT][NEUTRAL] Um,
[AGENT][NEUTRAL] Is she seeing
[AGENT][NEUTRAL] Her primary care due to an accident or an injury or is it just for routine?
[CUSTOMER][NEUTRAL] Um, it's just for a 15 minute office visit, um, looks like for, um, some routine maybe going over some labs, um, talking about some health issues.
[AGENT][NEUTRAL] OK. I'm not seeing um office visits being covered under this policy.
[AGENT][NEUTRAL] Let me let me double check because I'm not seeing it in the policy.
[CUSTOMER][NEUTRAL] So she can't go to a primary care doctor visit her.
[AGENT][NEUTRAL] Right.
[CUSTOMER][NEUTRAL] Family doctor.
[AGENT][NEUTRAL] Um, not with this policy.
[AGENT][NEUTRAL] Let me see.
[AGENT][NEUTRAL] And because this is just for a hospital.
[CUSTOMER][NEUTRAL] So does is it showing just hospital, um,
[CUSTOMER][NEUTRAL] Just hospital coverage like for no outpatient only hospital.
[AGENT][NEUTRAL] Yes.
[AGENT][NEUTRAL] Right. And let me see if she has a primary insurance.
[AGENT][NEUTRAL] This is supplemental.
[AGENT][NEUTRAL] Um, I'm not able to see if she has a major medical plan.
[CUSTOMER][NEUTRAL] Oh
[CUSTOMER][NEGATIVE] Oh this is supplemental because if she's in it's loaded as generic on my end that's why I'm calling because I don't even I don't even they scanned it in it's not a insurance that I even recognize um so it's saying that.
[AGENT][NEUTRAL] Mhm.
[AGENT][NEUTRAL] It's not a major medical plan.
[CUSTOMER][NEUTRAL] OK, so it's showing on your end that she has another insurance possibly?
[AGENT][NEGATIVE] Um, not one that would work for this. It's like short-term disability and
[AGENT][NEUTRAL] Accident, but not anything that has an office visit.
[CUSTOMER][NEUTRAL] OK, because I'm gonna have to call the patient. I just, OK, I'm just trying to make sure I.
[AGENT][NEUTRAL] And I can't see
[AGENT][NEUTRAL] Yeah, you'll need to see if she has a primary insurance. Mhm.
[CUSTOMER][POSITIVE] OK, thank you.
[CUSTOMER][NEUTRAL] Just trying to get my verbiage right so you so you so she has hospital coverage only no outpatient for PCP coverage.
[AGENT][NEUTRAL] Um, no, I am showing she has a physician office, but I believe it's due to, it's a treatment, a physician's office treatment, and it needs to be due to an accident or illness for this particular policy.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK, OK, OK, and then can I get a reference number and your name for this call?
[AGENT][NEUTRAL] So we don't have reference numbers, but you can use my name and last initial in today's date. So [PII], and today's date.
[CUSTOMER][NEUTRAL] OK, and that's [PII]
[AGENT][NEUTRAL] [PII] yes ma'am.
[CUSTOMER][NEUTRAL] [PII].
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] And is there anything else I can help you with?
[CUSTOMER][POSITIVE] No, I appreciate your time thank you so much.
[AGENT][POSITIVE] Alright, thank you for calling APL Juliet. Have a great day.
[CUSTOMER][NEUTRAL] Alright
[CUSTOMER][POSITIVE] Thank you you too bye bye.
[AGENT][NEUTRAL] Bye.