AccountId: 011433970860
ContactId: c587b473-a716-44d9-a9c4-35367211101c
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 287459 ms
Total Talk Time (AGENT): 161243 ms
Total Talk Time (CUSTOMER): 137200 ms
Interruptions: 4
Overall Sentiment: AGENT=1.4, CUSTOMER=0.2
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/02/10/c587b473-a716-44d9-a9c4-35367211101c_20250210T20:43_UTC.wav
--------------------------------------------
[AGENT][POSITIVE] Thanks for calling APL. This is [PII]. How may I assist you?
[CUSTOMER][NEUTRAL] Hey, Ms. [PII]. My name is [PII]. I'm calling from Wake Med Heart and Vascular. How are you doing?
[AGENT][POSITIVE] I'm good, Ms. [PII]. How are you today?
[CUSTOMER][NEUTRAL] OK, I'm just calling to verify um coverage on a patient that's coming in to see us tomorrow as a new patient.
[AGENT][NEUTRAL] Sure, I can assist you with that. Can I have a callback number for you, [PII] that policy number?
[CUSTOMER][POSITIVE] Thank you.
[CUSTOMER][NEUTRAL] Uh, my callback number is [PII] and option 4 gets us directly.
[AGENT][NEUTRAL] Mhm.
[AGENT][POSITIVE] Thank you.
[CUSTOMER][NEUTRAL] And his um and his subscriber ID number that he gave me is 02579860 and [PII] is his name.
[AGENT][NEUTRAL] And what is [PII]'s date of birth?
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] And you're calling to verify benefits eligibility for office visit?
[CUSTOMER][NEUTRAL] Yes, he's he's seeing a cardiologist tomorrow.
[AGENT][POSITIVE] Thank you.
[CUSTOMER][NEUTRAL] With wake me heart and vascular.
[AGENT][NEUTRAL] So this policy is the limited hospital indemnity policy.
[CUSTOMER][NEUTRAL] Limited hospitals.
[AGENT][NEUTRAL] Mhm.
[AGENT][NEUTRAL] Right. Yes, ma'am. And so.
[CUSTOMER][NEUTRAL] So this would cover and this would cover an office visit?
[AGENT][NEUTRAL] So as I just stated that the policy is a limited hospital indemnity policy, which the member has office visit benefits paid up to $75.
[CUSTOMER][NEUTRAL] Is that what you're saying?
[CUSTOMER][NEUTRAL] He does have office visit. OK, office benefits.
[AGENT][POSITIVE] Or do you want me to allow you to talk cause every time I talk, we both talk together so I can allow you to talk. Please ask your questions and then I'll answer them. Are you sure?
[CUSTOMER][NEUTRAL] I'm, I'm so sorry I'm so sorry, please forgive me.
[CUSTOMER][NEUTRAL] That's OK.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] I'm sure, go ahead, go ahead. I apologize.
[AGENT][NEUTRAL] The member has office visit benefits of $75 per visit with 5 visits per calendar year.
[AGENT][NEUTRAL] And this is not a guarantee of benefits just a disclaimer of the policy's coverage.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] And this policy has been active since [PII] and it's currently active, and I apologize, what was your name?
[CUSTOMER][NEUTRAL] Yes.
[CUSTOMER][NEUTRAL] He's [PII].
[AGENT][POSITIVE] Thank you, [PII].
[CUSTOMER][NEUTRAL] Is [PII] with white man.
[AGENT][POSITIVE] Thank you. Is there anything else that I can assist you with today, [PII]?
[CUSTOMER][NEUTRAL] OK
[CUSTOMER][NEUTRAL] Can you, can you fax that information to me?
[AGENT][NEUTRAL] No, ma'am. We can't fax this information.
[CUSTOMER][NEUTRAL] OK, all right, but um, but can you give me a reference number for?
[AGENT][NEUTRAL] Cause it's not a primary insurance.
[CUSTOMER][NEUTRAL] OK. It's not a primary insurance.
[AGENT][NEUTRAL] No, ma'am.
[CUSTOMER][NEUTRAL] So is this supposed to go to um because he's saying this is his only insurance.
[AGENT][NEUTRAL] This is a hospital indemnity. It's a limited hospital indemnity policy. It's not a primary insurance policy like Cigna.
[CUSTOMER][NEUTRAL] Right. It's a limited hospital.
[AGENT][NEUTRAL] Um, Aetna, mhm, yes, but it covers office visits. We will pay office visits up to $75. Say if your office visit is about $125 we will pay the $75 then the patient will will be responsible for the remaining balance.
[CUSTOMER][NEUTRAL] A deity.
[CUSTOMER][NEUTRAL] And
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Oh, OK, uh, does it, does the patient aware of that?
[AGENT][NEUTRAL] Um, I'm not sure if he's ever called to verify his benefits, but I'm pretty sure that the agent who
[AGENT][NEUTRAL] We're at their employer when they signed up for their benefits for the year. I'm pretty sure they explained it to him, but I'm not sure, but I'm not sure if he's ever called to verify his benefits.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] But a lot of
[CUSTOMER][NEUTRAL] OK, so I might, I might need to let him be aware of that because his, his visit with us would be like $243.
[AGENT][NEUTRAL] Then he will be responsible for the
[CUSTOMER][NEUTRAL] So if he would be responsible less than $75.
[AGENT][NEUTRAL] After we, yes, he don't have a deductible, co-pay or co-insurance, but he definitely will be responsible for the bill after the $75 has been paid.
[CUSTOMER][NEUTRAL] Right.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK, OK, I just say here and what is the name of this insurance company again?
[AGENT][NEUTRAL] This is American Public Life.
[CUSTOMER][NEUTRAL] American Public Life, OK.
[AGENT][NEUTRAL] Public life.
[AGENT][NEUTRAL] But his policy is a third party administra. His policy is through a third party administrator.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK and um can I get a reference number for our call today please?
[AGENT][NEUTRAL] We don't provide those [PII] unfortunately, however, you can use my name and today's date as a reference. We don't provide reference numbers.
[CUSTOMER][NEUTRAL] OK, and please, oh no, OK, what is your first name spell it for me.
[AGENT][NEUTRAL] [PII], and today's date as a reference.
[CUSTOMER][POSITIVE] OK, alright, thank you so much, Ms. [PII].
[AGENT][POSITIVE] You're welcome, [PII]. Thanks for calling APL. Have a good day. Goodbye.
[CUSTOMER][NEUTRAL] You do the same bye bye.