AccountId: 011433970860
ContactId: c0e64d20-27ef-413c-9c85-e2b0d506fb15
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 146100 ms
Total Talk Time (AGENT): 97161 ms
Total Talk Time (CUSTOMER): 34563 ms
Interruptions: 0
Overall Sentiment: AGENT=1.3, CUSTOMER=0.4
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/01/17/c0e64d20-27ef-413c-9c85-e2b0d506fb15_20250117T19:36_UTC.wav
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[AGENT][POSITIVE] Thank you for contacting APR. My name is [PII]. How may I help you?
[CUSTOMER][NEUTRAL] Hi, yes, I'm calling for benefits and eligibility.
[AGENT][NEUTRAL] I can help with benefits and eligibility with whom am I speaking, please?
[CUSTOMER][NEUTRAL] [PII]
[AGENT][NEUTRAL] OK, OK, thank you. What is that policy number we're looking at today?
[CUSTOMER][NEUTRAL] 02064065
[AGENT][NEUTRAL] Thank you. And the patient's name and date of birth, please?
[CUSTOMER][NEUTRAL] [PII] [PII].
[AGENT][NEUTRAL] Thank you. Is there a callback number I can have in the event that we're disconnected?
[CUSTOMER][NEUTRAL] [PII]
[AGENT][NEUTRAL] Thank you. The policy went into effect on [PII]. It is active. Now this is a secondary or gap insurance that's meant to pick up the deductible, co-payment or co-insurance for inside uh uh inpatient hospital.
[AGENT][NEUTRAL] As well as outpatient hospital.
[CUSTOMER][NEUTRAL] It
[CUSTOMER][NEUTRAL] OK, and the plan pays up to how much?
[AGENT][NEUTRAL] It, uh, for, uh, what it is is it's per occasion. And so, uh, for each occasion, uh, for each illness, it's $500 per occasion. That's just a, a verification of the benefit is not a guarantee of payment. For each in-hospital stay, it's uh $5000. Again, just a verification the benefit is not a guarantee of payment. So there's not, there's not a calendar year balance or a calendar year maximum. It just pays per occasion.
[CUSTOMER][NEUTRAL] Per calendar year?
[CUSTOMER][NEUTRAL] For your diagnosis?
[AGENT][POSITIVE] That's correct, yes.
[CUSTOMER][NEUTRAL] OK. So it's $500 per diagnosis a day?
[AGENT][NEUTRAL] Uh, for the, for the, for the complete, uh, um, uh, event, and then it renews every 90 days. So, um, if somebody had a broken ankle, uh, you know, on [PII] and we paid out that, that $500 if, if they broke that, that same ankle again, it would be another 90 days before we would pay that $500. It's it's $500 per occasion and uh the occasions are separated by 90 days.
[CUSTOMER][NEUTRAL] For a year.
[CUSTOMER][NEUTRAL] OK, um, perfect, and a reference number?
[AGENT][NEUTRAL] My name is [PII]. The first letter of my last name is [PII]. We're gonna use that in today's date as a reference. Is there anything else at all I can help with?
[CUSTOMER][NEUTRAL] OK
[CUSTOMER][POSITIVE] No, thank you. Have a great day.
[AGENT][POSITIVE] Thanks for contacting ATO have a good day.