AccountId: 011433970860
ContactId: db1035d8-42f9-4f3a-b1a6-44b366119bef
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 474640 ms
Total Talk Time (AGENT): 209373 ms
Total Talk Time (CUSTOMER): 116824 ms
Interruptions: 0
Overall Sentiment: AGENT=0.4, CUSTOMER=0.3
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/03/25/db1035d8-42f9-4f3a-b1a6-44b366119bef_20250325T21:52_UTC.wav
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[AGENT][NEUTRAL] Thank you for calling APL. This is [PII]. How may I help you?
[CUSTOMER][NEUTRAL] Hi, Ms. [PII]. This is uh [PII]. I'm calling from Arkansas Children's Hospital. I am calling to see if I can get some eligibility on a patient. Um, we have a, a different coverage and I talked to mom and she gave me this information, but I was trying to get it on the portal, but it doesn't seem like I'm able to pull it up.
[AGENT][NEUTRAL] OK, yes, Ms. [PII], I can help you with the eligibility. Uh, may I please get your callback number just in case the call gets disconnected?
[CUSTOMER][NEUTRAL] Yes, ma'am. It's [PII].
[AGENT][NEUTRAL] [PII]. OK, thank you. And then what is the patient's name, date of birth, and policy number?
[CUSTOMER][NEUTRAL] And that's a direct line.
[CUSTOMER][NEUTRAL] OK, I have [PII] and the date of birth is [PII], and she gave me 02582808.
[AGENT][NEUTRAL] OK, let me pull up that policy for us real quick.
[AGENT][NEUTRAL] I do show that [PII] does have an active policy and his effective date is [PII].
[CUSTOMER][NEUTRAL] OK, now, does he have like a deductible? Is that the policy number?
[AGENT][NEUTRAL] Yes, the 258-2808 is the policy number.
[AGENT][NEUTRAL] And let me look um if he has any deductibles.
[AGENT][NEUTRAL] I do not see any deductibles on the policy. This is a limited hospital indemnity plan.
[CUSTOMER][NEUTRAL] A limited hospital.
[AGENT][NEUTRAL] Yes, it's not the major medical.
[CUSTOMER][NEUTRAL] Aimity plan. OK, so is there an out of pocket?
[AGENT][NEUTRAL] Yes.
[AGENT][NEUTRAL] No, there's not what they have and this is just to verify benefits it's not a guarantee of payment, is he going to be inpatient or outpatient?
[CUSTOMER][NEUTRAL] It's outpatient.
[AGENT][NEUTRAL] Outpatient. OK, so he has um.
[AGENT][NEUTRAL] A physician's office visit for accident or sickness.
[AGENT][NEUTRAL] Uh, let's say 4 visits per calendar year.
[AGENT][NEUTRAL] And it pays.
[AGENT][NEUTRAL] $150.
[CUSTOMER][NEUTRAL] OK. So he has a heart condition, so would that be covered?
[AGENT][NEUTRAL] Mhm.
[AGENT][NEUTRAL] If it's in a physician's office, ER, urgent care center, ambulatory center.
[CUSTOMER][NEUTRAL] OK. I mean, the provider is at the hospital.
[AGENT][NEUTRAL] Right, so it's gonna be um an outpatient hospital facility?
[CUSTOMER][NEUTRAL] Yes ma'am.
[AGENT][NEUTRAL] That would be considered um physician's office.
[CUSTOMER][NEUTRAL] OK. OK. OK. And so, um, he is also having an echocardiogram that day.
[AGENT][NEUTRAL] OK, let me pull up the policy and see if there's anything in there that states about an echocardiogram.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] That's gonna be just a minute while the computer pulls it in for us.
[AGENT][NEUTRAL] Is echocardiogram considered a diagnostic test?
[CUSTOMER][NEUTRAL] Yes ma'am.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] Let me look and see for diagnostic.
[AGENT][NEUTRAL] I can read policies, but I don't know all the, all the jargon for the, for the hospital.
[CUSTOMER][NEUTRAL] Right.
[AGENT][NEUTRAL] OK, let me find his schedule of benefits real quick.
[AGENT][POSITIVE] OK, he has a diagnostic testing benefit.
[AGENT][NEUTRAL] Um, we will pay the diagnostic test, testing benefit per day when a covered person receives one of the diagnostic tests listed below. Magnetic, it's an MRI, a CAT scan, a thyroid.
[AGENT][NEUTRAL] An RAIU or a CT or a PET scan.
[CUSTOMER][NEUTRAL] OK, well, this is just an ultrasound.
[AGENT][NEUTRAL] OK, let me see if there's anything for ultrasound.
[AGENT][NEUTRAL] I'm still looking.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] It's a pretty big.
[AGENT][NEUTRAL] Policy
[AGENT][NEUTRAL] OK. According to
[AGENT][NEUTRAL] The policy, it should be covered if done in.
[AGENT][NEUTRAL] Outpatient facility which would be the office with his office visits.
[CUSTOMER][NEUTRAL] Yes.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] So it'd be $150 flat flat fee.
[CUSTOMER][NEUTRAL] OK, so
[CUSTOMER][NEUTRAL] Toward the echo and the office visit.
[AGENT][NEUTRAL] Not towards both, um, it goes by facility.
[AGENT][NEUTRAL] So in the uh.
[CUSTOMER][NEUTRAL] So just flat.
[AGENT][NEUTRAL] Right, just a flat 150.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK, just total, OK.
[AGENT][NEUTRAL] Yes, ma'am. Wait a minute, wait a minute, let me look. Wait.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] There is um.
[AGENT][NEUTRAL] One diagnostic testing.
[AGENT][NEUTRAL] Of $100.
[CUSTOMER][NEUTRAL] So it would pay $100.
[AGENT][NEUTRAL] Yes.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] So 150 to the doctor's visit and 100 to the ultrasound.
[AGENT][NEUTRAL] Yes, that's the way the policy is rating.
[CUSTOMER][NEUTRAL] OK, alright, and Ms. Try, can I get the initial, how do you spell your name?
[AGENT][NEUTRAL] It's [PII]
[CUSTOMER][NEUTRAL] Alright, and can I get the initial to your last name?
[AGENT][NEUTRAL] It's A
[CUSTOMER][NEUTRAL] OK, and a call reference?
[AGENT][NEUTRAL] You can use my name and today's date.
[CUSTOMER][NEUTRAL] OK, and it is called American Public Life, correct?
[AGENT][NEUTRAL] Yes, ma'am.
[CUSTOMER][POSITIVE] OK, alright then, thank you so much.
[AGENT][POSITIVE] You're very welcome. Is there anything else I can help you with, Ms. [PII], before we go?
[CUSTOMER][NEUTRAL] No, ma'am.
[AGENT][POSITIVE] All right. Well, you have a great night and thank you for calling APL.
[CUSTOMER][POSITIVE] All right thank you bye bye.
[AGENT][NEUTRAL] Bye-bye.