AccountId: 011433970860
ContactId: c75eee03-4545-471c-92df-6053ae018b27
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 265059 ms
Total Talk Time (AGENT): 112634 ms
Total Talk Time (CUSTOMER): 124540 ms
Interruptions: 0
Overall Sentiment: AGENT=1, CUSTOMER=0.2
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/03/25/c75eee03-4545-471c-92df-6053ae018b27_20250325T16:17_UTC.wav
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[AGENT][NEUTRAL] Good morning. Thank you for calling APL. This is [PII]. How may I assist you?
[CUSTOMER][NEUTRAL] Yes, my name is [PII] and I'm calling from a provider's office. I'm calling because I need to see what type if this patient's plan is like a full medical plan or what type of policy it is please.
[AGENT][NEUTRAL] OK. Oh, sure, I can assist you with plan information. And may I have a callback number just in case we get disconnected Miss [PII]?
[CUSTOMER][NEUTRAL] Yes, it is [PII].
[AGENT][NEUTRAL] Thank you. And what's the name of the um the provider, I'm sorry, or the facility you're calling from?
[CUSTOMER][NEUTRAL] BHS physicians Network and we're a physician group, a multi-specialty.
[AGENT][NEUTRAL] OK, thank you. And do you have the policy number of the patient?
[CUSTOMER][NEUTRAL] Yes, it is D as in Delta 43,302,090.
[AGENT][NEUTRAL] Um, do you see a policy certificate number? It's gonna start with a 0 followed by 7 digits. That's gonna be our number.
[CUSTOMER][NEUTRAL] Let me see.
[CUSTOMER][NEUTRAL] Uh, 0, OK, how about 02474924?
[AGENT][NEUTRAL] OK, yeah, that sounds more like us. Let's see.
[AGENT][NEUTRAL] Alright, and may I have the name and date of birth of the patient?
[CUSTOMER][NEUTRAL] It is [PII]
[CUSTOMER][NEUTRAL] And [PII] is the date of birth.
[AGENT][POSITIVE] Perfect. Thank you. All right. So this particular policy is one of our limited hospital indemnity policy.
[CUSTOMER][NEUTRAL] OK
[CUSTOMER][NEUTRAL] So it is limited.
[AGENT][NEUTRAL] Mm.
[AGENT][NEUTRAL] Yes, it is, let me know.
[CUSTOMER][NEUTRAL] So how did they cover because he was in the hospital, so does it only cover like one visit per day or how does it work?
[AGENT][NEUTRAL] All right. And was he, um, admitted or it was just like an ER visit?
[CUSTOMER][NEUTRAL] He was admitted.
[AGENT][NEUTRAL] It was submitted. OK, so this is not a guarantee of payment, just a verification of coverage and that's just a disclaimer. Um, the admission benefit is 1500.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] Per cover person per calendar year. This is one time. And then the daily hospital confinement benefit is 100 per day, up to 4 days.
[CUSTOMER][NEUTRAL] OK, 100 per day?
[AGENT][NEUTRAL] Yes.
[CUSTOMER][NEUTRAL] OK, so whosever claim gets there first.
[AGENT][NEUTRAL] Yes, basically.
[CUSTOMER][NEUTRAL] OK, daily 100 per.
[CUSTOMER][NEUTRAL] OK, that's why, well, I was wondering why the EOB had said that it was a duplicate and we were the only physician from our group practice, but that doesn't mean that another doctor from another group practice didn't see him.
[AGENT][POSITIVE] Correct.
[CUSTOMER][NEUTRAL] 24 days. OK, so it's daily 100 per day up to 4 days, correct?
[AGENT][POSITIVE] Correct.
[CUSTOMER][NEUTRAL] OK, so then we can build the patient then right? because.
[AGENT][NEUTRAL] Yeah, it's up to the provider's discretion because since it's not a major medical, it's just a limited plan. We don't really have any contractual involvement on any remaining of the claim.
[CUSTOMER][NEUTRAL] Pre
[CUSTOMER][NEUTRAL] Uh huh.
[CUSTOMER][NEUTRAL] Yeah, OK, and can you tell me your name again please?
[AGENT][NEUTRAL] Mhm.
[AGENT][NEUTRAL] Sure. My name is [PII], that's initial [PII].
[CUSTOMER][NEUTRAL] Um, OK, and is there a reference number for our call?
[AGENT][NEUTRAL] We don't have reference numbers you can use my name in today's date if you would like, Ms. [PII].
[CUSTOMER][NEUTRAL] Yeah
[CUSTOMER][POSITIVE] OK, I appreciate your help thank you so much have a great day.
[AGENT][POSITIVE] You're welcome. You as well, and thank you for calling APR. Have a good day. Bye-bye.
[CUSTOMER][NEUTRAL] Uh huh bye.
[AGENT][NEUTRAL] Yeah.