AccountId: 011433970860
ContactId: ba7b4af9-3e80-4f74-9865-30e9ece1a815
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 418739 ms
Total Talk Time (AGENT): 195856 ms
Total Talk Time (CUSTOMER): 103186 ms
Interruptions: 2
Overall Sentiment: AGENT=0.7, CUSTOMER=-0.1
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/04/30/ba7b4af9-3e80-4f74-9865-30e9ece1a815_20250430T15:22_UTC.wav
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[AGENT][POSITIVE] Good morning. Thank you for calling APL. This is [PII]. How can I help you?
[CUSTOMER][NEUTRAL] Hi [PII], this is [PII], um, with SIU physicians and surgeons. Um, I was calling. I have a patient of ours that has APL.
[AGENT][NEUTRAL] Mhm.
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Um, OK, is APL in general.
[CUSTOMER][NEUTRAL] A medical type of insurance.
[AGENT][NEUTRAL] It's not a major medical insurance company. We offer different types of worksite benefits and we have different plan options available, but I would just have to pull up the member's policy to tell you what type of coverage they have with us, if that's what you're needing to know.
[CUSTOMER][NEUTRAL] OK
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Alright, I have a policy, yeah, I have a policy number.
[AGENT][NEUTRAL] OK, so first off, [PII], what is the
[CUSTOMER][NEGATIVE] It is 0.
[AGENT][NEUTRAL] Well, go ahead and give me your callback number first off.
[CUSTOMER][NEUTRAL] Go ahead.
[CUSTOMER][NEUTRAL] [PII].
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] OK, thank you. And then the policy number now?
[CUSTOMER][NEUTRAL] 02606210
[AGENT][NEUTRAL] OK, can you give me a couple of moments please to get the member's information pulled up.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] So are you needing eligibility and benefits, [PII]?
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] Or just eligibility or?
[CUSTOMER][NEUTRAL] Um, eligibility and benefits probably.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] Well, bear with me just a moment because I've got to reopen something here, [PII]. I'm sorry.
[CUSTOMER][POSITIVE] OK, I'm sorry.
[AGENT][NEUTRAL] OK, and [PII], again, any information provided would be a verification of benefits and not a guarantee of payment. What is the patient's name and date of birth?
[CUSTOMER][NEUTRAL] It is [PII] [PII].
[AGENT][NEUTRAL] OK, thank you. So I did say she is the subscriber on this hospital indemnity limited benefit plan.
[AGENT][NEUTRAL] And it does have an effective date of [PII].
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] And it is still showing as active at this point.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Let me see.
[CUSTOMER][NEUTRAL] OK, so that wouldn't cover like everyday doctor's appointments or pain injections, stuff like that?
[AGENT][NEUTRAL] OK, so again it is a limited benefit plan and on this policy she has an outpatient sickness writer for office visits and the maximum benefit per visit is $75 and a maximum number of visits per calendar year of 5.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] So it'll only cover the provider visit.
[CUSTOMER][NEUTRAL] OK, because the providers wanting to do an epidural injection pain like a pain injection.
[AGENT][NEUTRAL] Now
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEGATIVE] And it probably is not gonna cover that.
[AGENT][NEUTRAL] Uh.
[AGENT][NEUTRAL] On an outpatient basis.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] Let me look at one other benefit on this policy.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] OK, and I mean, what type of setting again, I'm so sorry. What, Nicole did you say it's gonna be done in?
[CUSTOMER][NEUTRAL] Outpatient
[CUSTOMER][NEUTRAL] Like outpatient hospital.
[AGENT][NEUTRAL] Uh, like a surgeries, the surgical, ambulatory surgical center.
[CUSTOMER][NEUTRAL] Or outpatient facility.
[CUSTOMER][NEUTRAL] Kind of yeah.
[AGENT][NEUTRAL] And the reason I'm gonna asking you this, let's see, is because there is
[AGENT][NEUTRAL] She does have a surgical and anesthesia benefit rider.
[AGENT][NEUTRAL] Now what I would just recommend is, you know, I can't say for sure it's gonna be dependent upon the review of the claim.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][POSITIVE] But there is a benefit for an ambulatory surgical center.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] And the surgical benefits.
[AGENT][NEUTRAL] Let's see. Mm.
[AGENT][NEUTRAL] I'm still looking at that one.
[AGENT][NEUTRAL] But it's OK, so on the surgical benefits, it states the surgery and, and I don't know if this would be, be considered surgery or not. Um.
[CUSTOMER][NEGATIVE] It's not.
[AGENT][NEUTRAL] OK, so then no, there would not be any benefits.
[CUSTOMER][NEUTRAL] OK. Yeah, no, it wouldn't be considered a surgery. It's just an injection. Um, OK, I'll give the patient a call.
[AGENT][NEUTRAL] OK, so yes, so it would be that office, yeah, that benefit amount that I first gave you would be the benefit then on this policy for a visit.
[CUSTOMER][NEUTRAL] OK, 75 per visit.
[AGENT][NEUTRAL] Now and if you won't end up filing a claim with us for this number once the claim has been processed, [PII], we do have, excuse me, we do have a portal that you should be able to check claim status in.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] And that
[CUSTOMER][NEUTRAL] On your website.
[AGENT][NEUTRAL] Uh-huh, it's [PII], OK.
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] I got it. I, I have it pulled up that's how I get your phone number. I just didn't know what author like we don't have to have any kind of authorizations or anything.
[AGENT][POSITIVE] Oh, OK. I got you.
[AGENT][NEUTRAL] And there's no prior.
[AGENT][NEUTRAL] No, there is not.
[CUSTOMER][NEUTRAL] OK, that's what was my next question. OK, no, that's all I had. Thank you.
[AGENT][NEUTRAL] Mhm
[AGENT][POSITIVE] OK, well, you're very welcome. So if that is all I can help you with. Thank you again for calling APL and I hope that you have a great day.
[CUSTOMER][POSITIVE] You as well thank you.
[AGENT][POSITIVE] Yes, ma'am. Thank you too.
[CUSTOMER][NEUTRAL] Alright bye bye.
[AGENT][NEUTRAL] Bye-bye.