AccountId: 011433970860
ContactId: ce166990-0586-428e-8cdc-b418adf93113
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 391500 ms
Total Talk Time (AGENT): 122319 ms
Total Talk Time (CUSTOMER): 146517 ms
Interruptions: 2
Overall Sentiment: AGENT=0.8, CUSTOMER=-0.1
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/05/27/ce166990-0586-428e-8cdc-b418adf93113_20250527T13:51_UTC.wav
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[AGENT][POSITIVE] Good morning. Thank you for calling APL. This is [PII]. May I help you?
[CUSTOMER][NEUTRAL] Hi, my name is [PII]. I'm calling from doctor's office regarding, can I get this uh LTM benefit? Can you help me with that?
[AGENT][POSITIVE] Sure, I can verify benefits for you and I apologize, your name is again?
[CUSTOMER][NEUTRAL] A
[CUSTOMER][NEUTRAL] My name is [PII].
[AGENT][NEUTRAL] OK, and [PII], what is the policy number, please?
[CUSTOMER][NEUTRAL] And that's the policy ID number or?
[CUSTOMER][NEUTRAL] 02597814.
[AGENT][POSITIVE] Thank you, one moment.
[AGENT][NEUTRAL] And do you have a callback number in case the call drops?
[CUSTOMER][NEUTRAL] My callback number is [PII] and that is the direct line.
[AGENT][NEUTRAL] OK. And verify the patient's name, date of birth.
[CUSTOMER][NEUTRAL] And the first name is [PII] and the last name is [PII] and the date of birth is [PII].
[AGENT][NEUTRAL] OK, I'm showing an effective date of [PII]. Policy is active. And what benefits are you needing for this patient?
[CUSTOMER][NEUTRAL] It's [PII].
[AGENT][NEUTRAL] [PII] is the effective date.
[CUSTOMER][NEUTRAL] There is no time date?
[AGENT][NEUTRAL] No, policy is active.
[CUSTOMER][NEUTRAL] Can I get the sufficient PA name, please?
[AGENT][NEUTRAL] HR
[AGENT][NEUTRAL] That's for hospital indemnity.
[CUSTOMER][NEUTRAL] For the SA plan?
[AGENT][NEUTRAL] I'm sorry?
[CUSTOMER][NEUTRAL] Can I get the sufficient plan name?
[AGENT][NEUTRAL] I can't hear you, sir. Can you turn up the volume just a little bit? Say again.
[CUSTOMER][NEUTRAL] Yeah. Can I get the sufficient plan name?
[AGENT][NEUTRAL] It's called HI.
[AGENT][NEUTRAL] It stands for hospital indemnity.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Can I get the sufficient plan, uh, the provider of, uh, in-network or out of network?
[AGENT][NEUTRAL] Oh, we don't have a network.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Can I get a sufficient PCP office visit for co-pay and co-insurance, please?
[AGENT][NEUTRAL] Uh, there's no co-pay or co-insurance on the plan. Hold on one moment, please.
[CUSTOMER][NEUTRAL] Like
[CUSTOMER][NEUTRAL] Sorry?
[CUSTOMER][NEUTRAL] OK
[AGENT][NEUTRAL] OK, um, not a guarantee of payment, just a verification of coverage for an office visit. The max payable is up to $50 per day, and they have a total of 4 visits per year.
[CUSTOMER][NEUTRAL] It is $50 per visit. It is a 4.
[AGENT][NEUTRAL] Per day, up to 4 visits total per year.
[CUSTOMER][NEUTRAL] Oh.
[CUSTOMER][NEUTRAL] Or is it per policy, am I right?
[AGENT][NEUTRAL] Per calendar year.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] And so, can I get the question how many visits are used today and this remaining visits, please?
[AGENT][NEUTRAL] I'm sorry, say again.
[CUSTOMER][NEUTRAL] How many visits are remaining?
[AGENT][NEUTRAL] All 4. I don't show that the patient has used any visits for this year.
[CUSTOMER][NEGATIVE] Nothing has been used.
[CUSTOMER][NEUTRAL] Can I get the sufficient uh the patient tab any other authorization to put on file?
[CUSTOMER][NEUTRAL] So
[AGENT][NEUTRAL] If they have any what? I'm sorry.
[CUSTOMER][NEUTRAL] A authorization referral on file?
[AGENT][NEUTRAL] We don't require any prior authorization.
[CUSTOMER][NEUTRAL] OK. And that's can I get the patient to have any other coordination of benefit.
[AGENT][NEUTRAL] No.
[CUSTOMER][NEUTRAL] Uh, can I get the sufficient, uh,
[CUSTOMER][NEGATIVE] I no coordination of benefit.
[CUSTOMER][NEUTRAL] Yes, 261.
[CUSTOMER][NEUTRAL] Uh, so can I get the sufficient uh claim fax number?
[AGENT][NEGATIVE] I'm not understanding what you're asking.
[CUSTOMER][NEUTRAL] It's fax number, claim fax number.
[AGENT][NEUTRAL] The claims fax number? Sure, [PII].
[CUSTOMER][NEUTRAL] Yeah
[CUSTOMER][NEUTRAL] Yeah
[CUSTOMER][NEUTRAL] Claim payer ID.
[AGENT][NEUTRAL] Pay ID is 64556.
[CUSTOMER][NEUTRAL] Sure
[CUSTOMER][NEUTRAL] My mailing address please.
[AGENT][NEUTRAL] [PII].
[CUSTOMER][NEUTRAL] Right
[CUSTOMER][NEUTRAL] Yes, is [PII].
[CUSTOMER][NEUTRAL] $1080 even.
[CUSTOMER][NEUTRAL] Can I get your name, please?
[AGENT][NEUTRAL] Sure, it's [PII] last initial [PII].
[CUSTOMER][NEUTRAL] Uh yeah.
[CUSTOMER][NEUTRAL] OK, can I get just a call reference?
[AGENT][NEUTRAL] Uh, you may use my name in today's date if you like.
[CUSTOMER][NEUTRAL] [PII]
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Queue and today's date.
[AGENT][POSITIVE] Correct.
[CUSTOMER][POSITIVE] Thank you so much. I really appreciate it. Thank you so much.
[AGENT][POSITIVE] You're welcome. Thanks for calling APL. Have a great day, [PII]. Bye.