AccountId: 011433970860
ContactId: cc04a62b-f07d-4669-9172-cb86b59876e2
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 490950 ms
Total Talk Time (AGENT): 193739 ms
Total Talk Time (CUSTOMER): 93013 ms
Interruptions: 1
Overall Sentiment: AGENT=1.1, CUSTOMER=1.1
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/04/30/cc04a62b-f07d-4669-9172-cb86b59876e2_20250430T15:24_UTC.wav
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[AGENT][NEUTRAL] Thank you for calling APL. This is [PII]. How may I help you?
[CUSTOMER][NEUTRAL] Hi, my name is [PII]. I was calling to get eligibility and benefit information.
[AGENT][NEUTRAL] OK, Miss [PII], I can help you with the eligibility and benefits of a patient. Can I please get your callback number and the name of the facility you're calling from?
[CUSTOMER][NEUTRAL] Yeah, callback number is [PII]. That's correct, and the name of the facility is um the Christ Hospital.
[AGENT][POSITIVE] OK, thank you so much. And then what is the patient's name, date of birth, and policy number?
[CUSTOMER][NEUTRAL] [PII]
[CUSTOMER][NEUTRAL] Date of birth is [PII] and policy number um.
[CUSTOMER][NEUTRAL] I have two. I think the one that you would have is 259-6148.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] OK, let me look that one up first.
[AGENT][NEUTRAL] Yes, I do shower.
[AGENT][NEUTRAL] OK, [PII] does have an active policy with us. Her effective date is [PII], and this is just to verify her benefits. It's not a guarantee of payment. Is this gonna be inpatient or outpatient?
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Outpatient
[AGENT][NEUTRAL] OK, let me see if she has any, she has an outpatient sickness benefit rider.
[AGENT][NEUTRAL] She gets, uh,
[AGENT][NEUTRAL] 4 visits per calendar year and they pay $75.
[CUSTOMER][NEUTRAL] OK, and if this visit is for um like routine labs, would that be covered or no?
[AGENT][NEUTRAL] She has um let's see let me pull up her complete policy and see if the lab is covered.
[AGENT][NEGATIVE] This is a limited benefit.
[AGENT][NEUTRAL] plan, so I wanna double check.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] It's gonna be just a moment while I pulls in.
[AGENT][NEUTRAL] All right.
[AGENT][NEUTRAL] It's just taking a moment to pull up this policy. I'm sorry, they're big policy so but I wanted to.
[AGENT][NEUTRAL] Make sure.
[AGENT][POSITIVE] Give you correct information.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] OK.
[AGENT][POSITIVE] OK, I do show that she does have a wellness.
[AGENT][NEUTRAL] The test benefit rider for wellness that pays um.
[AGENT][NEUTRAL] Wellness exam and or test benefit per test is $75. A diagnostic test would pay $250.
[CUSTOMER][NEUTRAL] OK, and do they have visit limit per year as well?
[AGENT][NEUTRAL] Uh they, yes, only um.
[AGENT][NEUTRAL] Let's see.
[AGENT][NEUTRAL] The wellness test is one time per year, but then her.
[AGENT][NEUTRAL] Policy states that she gets 4.
[AGENT][NEUTRAL] Outpatient visits per year.
[CUSTOMER][NEUTRAL] OK, and what network does the plan use?
[AGENT][NEUTRAL] Uh, it's our own. We don't use any specific network. They can go anywhere they want to.
[CUSTOMER][NEUTRAL] OK, so you guys don't use the multiplay network?
[AGENT][NEUTRAL] Well the multi plan is uh associated with us and yet we do use it but they don't have to use a multi plan provider.
[AGENT][POSITIVE] They can choose anywhere they want to go.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] So
[CUSTOMER][NEUTRAL] OK, so we're in network with multi plan so would that give the patient a contractual discount?
[AGENT][NEUTRAL] Uh, it, it would just go based on the how the policy is written. Our policy, we don't give discounts.
[AGENT][NEUTRAL] It's just a set limit for a covered procedure.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK, and um is this plan within another plan with 90 degree benefits?
[AGENT][NEUTRAL] Let me look and see if it is.
[AGENT][NEUTRAL] Yes ma'am.
[CUSTOMER][NEUTRAL] OK, so they're not two separate plans.
[AGENT][POSITIVE] No, that's correct.
[CUSTOMER][POSITIVE] Correct, it's just all one plan, this one's added, OK.
[AGENT][POSITIVE] Yes, ma'am, you're right.
[CUSTOMER][NEUTRAL] Um, and then
[CUSTOMER][NEUTRAL] Do you have the phone number for 90 Degree benefits?
[AGENT][POSITIVE] Yes, I do. Would you like that?
[CUSTOMER][NEUTRAL] Yes, please.
[AGENT][NEUTRAL] It's [PII].
[AGENT][NEUTRAL] [PII].
[AGENT][NEUTRAL] [PII].
[AGENT][NEUTRAL] And if you're looking up benefit provider information, uh, you would choose option one.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Alright and then um can I get your claims mailing address please?
[AGENT][NEUTRAL] Yes ma'am, it's [PII].
[AGENT][NEUTRAL] That's in [PII].
[AGENT][NEUTRAL] And the zip code is [PII].
[CUSTOMER][NEUTRAL] Do you have a payer ID as well?
[AGENT][NEUTRAL] Yes ma'am, that is 60801.
[CUSTOMER][NEUTRAL] Thank you and then can I get a call reference number please?
[AGENT][NEUTRAL] Yes, you can use my name.
[AGENT][NEUTRAL] [PII].
[AGENT][NEUTRAL] And today's date.
[CUSTOMER][POSITIVE] OK, thank you very much.
[AGENT][POSITIVE] You're very welcome, Miss [PII]. Is there anything else I can help you with before we go?
[CUSTOMER][POSITIVE] No, I think that's it thank you.
[AGENT][POSITIVE] Thank you you have a wonderful rest of your week and thanks for calling APL.
[CUSTOMER][POSITIVE] Thanks you too bye.
[AGENT][NEUTRAL] Mhm bye bye ma'am.