AccountId: 011433970860
ContactId: cd35674e-f6e5-4b3e-bc37-486b9f54560d
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 475549 ms
Total Talk Time (AGENT): 244884 ms
Total Talk Time (CUSTOMER): 133448 ms
Interruptions: 0
Overall Sentiment: AGENT=0.9, CUSTOMER=0.9
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/04/02/cd35674e-f6e5-4b3e-bc37-486b9f54560d_20250402T15:01_UTC.wav
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[AGENT][POSITIVE] Good morning. Thank you for calling APL. This is [PII]. How may I assist you?
[CUSTOMER][NEUTRAL] Hello, so, how are you doing?
[AGENT][POSITIVE] I'm good, thank you.
[AGENT][NEUTRAL] How about you?
[CUSTOMER][NEUTRAL] So, so I have a, I'm good, thanks for asking. I have a provider on the phone by the name of [PII]. She's calling to verify benefits for this for HR policy. I'm not sure if you're able to assist with that or not.
[AGENT][NEUTRAL] Mhm.
[AGENT][NEUTRAL] Oh.
[AGENT][NEUTRAL] OK, yes, I can. Um, so her name.
[CUSTOMER][NEUTRAL] Let me know when you're ready for the policy.
[AGENT][NEUTRAL] OK, go ahead.
[CUSTOMER][NEUTRAL] [PII] is the um provider.
[AGENT][NEUTRAL] Mhm.
[AGENT][NEUTRAL] OK, go ahead.
[CUSTOMER][NEUTRAL] And she's calling for policy 256-5007. It's 256-500007.
[AGENT][NEUTRAL] OK. Do you have a callback number for [PII]?
[CUSTOMER][NEUTRAL] I do. Her callback number is [PII].
[AGENT][POSITIVE] OK. All right. Thank you. I'm ready for her.
[CUSTOMER][POSITIVE] All righty. Thanks so. Have a good one.
[AGENT][POSITIVE] You're welcome. You too. Bye-bye.
[CUSTOMER][POSITIVE] Hello [PII]. I'm gonna transfer you over to Sol and she's gonna assist you further. Thanks for calling APL and have a great day. Goodbye. Thank you.
[AGENT][NEUTRAL] Good morning, Ms. [PII]. This is [PII] with the care team and I, I, I see that you're calling for a benefits on the hospital indemnity. Is that correct?
[CUSTOMER][NEUTRAL] Um, yeah.
[AGENT][NEUTRAL] Medical? OK. And uh what type of service is being rendered?
[CUSTOMER][NEUTRAL] Um, chemotherapy.
[AGENT][NEGATIVE] No, no.
[AGENT][NEUTRAL] Chemotherapy.
[AGENT][NEUTRAL] All right. And may I have the name and date of birth of the patient?
[CUSTOMER][NEUTRAL] [PII], [PII].
[AGENT][POSITIVE] OK, thank you.
[AGENT][NEUTRAL] And what's the name of the facility you're calling from, Ms. [PII]?
[CUSTOMER][NEUTRAL] Um, multi-care Tacoma General Allen More Hospital.
[AGENT][POSITIVE] OK, thank you.
[AGENT][NEUTRAL] All right.
[CUSTOMER][NEUTRAL] And I'm sorry, what was your name?
[AGENT][NEUTRAL] My name is [PII].
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] Last initial [PII].
[AGENT][NEUTRAL] Yeah, OK. And bear with me just a minute. Let me pull the benefits of this policy because this is a limited hospital indemnity plan. It is a limited plan. I need to check and see if we cover any type of cancer treatments. OK, one moment.
[AGENT][NEUTRAL] All right.
[CUSTOMER][NEUTRAL] Um, I'm sorry?
[AGENT][NEUTRAL] OK. So this one doesn't have any cancer treatment benefits. Um, it is limited to like hospital admission, confinements, surgeries, um.
[AGENT][NEUTRAL] Ambulance diagnostic, but it doesn't have any treatment for cancer.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] OK um.
[CUSTOMER][NEUTRAL] It's a hospital and I indemnity plan.
[AGENT][NEUTRAL] Yeah, hospital indemnity plan.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][POSITIVE] Um, OK, thank you.
[AGENT][NEUTRAL] You're welcome. Is there uh-huh.
[CUSTOMER][NEUTRAL] Where, sorry, you said you don't, you don't see any benefits for treatments?
[AGENT][NEGATIVE] No, I don't see any cancer treatment benefits under this one, no. Mhm.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] Mm OK. Is there anything else I'm gonna help you with today? Any other questions or any other benefits that you need to check on?
[CUSTOMER][NEUTRAL] Um, no, and then just your name and date for the call reference or for a call reference.
[AGENT][NEUTRAL] Reference, yes. Correct, yes. My name and today's date. Mhm.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][POSITIVE] OK, thank you. Um, and I'm sorry for
[AGENT][POSITIVE] You're welcome. Uh, yes, go ahead.
[CUSTOMER][NEUTRAL] For their hospital visits, is it a $50 benefit?
[AGENT][NEUTRAL] OK, let me give you the benefit, um,
[CUSTOMER][NEUTRAL] Per day.
[AGENT][NEUTRAL] It depends if it's a confinement or if it's just an in and out visit. OK. Um, so we have in and out, so like an emergency room or is it?
[CUSTOMER][NEUTRAL] In and out.
[CUSTOMER][NEUTRAL] Well, no, they had a claim, uh, a chemo.
[CUSTOMER][NEUTRAL] She has a plan where she received radiology, chemotherapy, um.
[CUSTOMER][NEUTRAL] And lab and it paid $50 so I'm just trying to confirm that that's correct.
[AGENT][NEUTRAL] Mhm.
[AGENT][NEUTRAL] OK, the $50 is for an office visit. I'm not sure if that's what it was paid for because we have a $50 per office visit for urgent care or emergency room. They're all $50. Now, if it's due to like an imaging test, we do have a specific diagnostic testing that we cover. And then we have um advanced follow-up test. So those are the only two that I see that um
[AGENT][NEUTRAL] are listed on the benefits, but I don't have like an outpatient benefit if that's what you're looking for. I don't have an outpatient benefit. It's only like for either office visit, urgent care or emergency room, and those are $50 per day for emergency room, it's $2 per year. Uh, for urgent care, it's $4 per year, and for physician's office, it's $4 per year.
[AGENT][NEUTRAL] I'm not sure if they just um charge it as an office visit, probably, and that's why they got the $50.
[CUSTOMER][NEUTRAL] OK, and then
[CUSTOMER][NEUTRAL] OK, and then, so that's um.
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] They don't have like or show any other coverage just the.
[AGENT][NEUTRAL] No, for
[CUSTOMER][NEUTRAL] Like the office visit pretty much.
[AGENT][NEUTRAL] Yeah, for outpatient facilities like hospitals, the only thing we cover is a sur[PII]. Like if there's a surgery done in the hospital or freestanding surgical center, there is a benefit of 250 per day, maximum of 1 day.
[AGENT][NEUTRAL] Um, so that will be the only outpatient, um, facility or outpatient service we cover will be surgery. Other than that, again, it's just gonna be the diagnostic testing, but we do have a specific diagnostic testing that we cover and then the office visit, which is um $50 per day maximum of 4 days.
[CUSTOMER][NEUTRAL] Um, can I check, can you check, um, a couple codes, or?
[CUSTOMER][NEUTRAL] Does it let you do that?
[AGENT][NEUTRAL] Oh,
[AGENT][NEUTRAL] Uh, I'm not gonna have a way of finding if uh how much we pay per per code um because we don't have a list like that, um, what type of service are they?
[CUSTOMER][NEUTRAL] Um, CBC.
[CUSTOMER][NEUTRAL] Like blood draw.
[AGENT][NEUTRAL] Oh if it's lab, this one doesn't cover lab.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] OK
[CUSTOMER][POSITIVE] OK, thank you.
[AGENT][NEUTRAL] You're welcome, and this is not a guarantee of payment, just a verification of coverage. Is there anything else I may help you with today, Miss [PII]?
[CUSTOMER][POSITIVE] Um, no, that's it, thank you.
[AGENT][POSITIVE] OK, you're welcome and thank you for calling APL. Have a good day.
[CUSTOMER][NEUTRAL] You too bye.
[AGENT][POSITIVE] Thank you. Bye-bye.