AccountId: 011433970860
ContactId: dfd3cbc2-0202-491a-87a7-a2deb058ca74
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 333529 ms
Total Talk Time (AGENT): 166265 ms
Total Talk Time (CUSTOMER): 91349 ms
Interruptions: 2
Overall Sentiment: AGENT=0.7, CUSTOMER=0.8
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/03/13/dfd3cbc2-0202-491a-87a7-a2deb058ca74_20250313T14:54_UTC.wav
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[AGENT][POSITIVE] Good morning. Thank you for calling APL. This is [PII]. How can I help you?
[CUSTOMER][NEUTRAL] Hi [PII], my name is [PII] and I was calling to for uh eligibility and benefits on a patient.
[AGENT][NEUTRAL] OK, [PII], you're needing eligibility and benefits. Is that correct?
[CUSTOMER][POSITIVE] Uh, well, mainly benefits.
[CUSTOMER][NEUTRAL] Well, yeah, well, yeah, eligibility if you can, if you can, I what I do need it. OK.
[AGENT][NEUTRAL] OK, yes, ma'am. I can, I can do both of those, ma'am. OK, so what is a good callback number for you, please?
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] It's [PII].
[AGENT][NEUTRAL] Thank you. And the member's policy number?
[CUSTOMER][NEUTRAL] It's 02598202.
[AGENT][NEUTRAL] Thank you, one moment, [PII], while I get the member's information pulled up please.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] All
[AGENT][NEUTRAL] And any information payment that I do provide today would be a verification of benefits and not a guarantee of payment. What is your patient's name and date of birth?
[CUSTOMER][NEUTRAL] OK her name is.
[CUSTOMER][NEUTRAL] [PII].
[CUSTOMER][NEUTRAL] And her date of birth, let me get the date of birth.
[AGENT][NEUTRAL] Sure.
[CUSTOMER][NEUTRAL] [PII].
[AGENT][POSITIVE] OK, thank you.
[AGENT][NEUTRAL] OK, so I do show she is the spouse of the subscriber on this limited benefit plan and it is Active Pam with an effective date of [PII].
[AGENT][NEUTRAL] And what type of benefit information do you need for her inpatient, outpatient or office?
[CUSTOMER][NEUTRAL] Um, it's off, it will, it's surgery, but it's in an office setting.
[AGENT][NEUTRAL] OK, one moment.
[AGENT][NEUTRAL] Mm
[AGENT][NEUTRAL] OK, so on her benefits on this limited benefit plan, she has an accident and sickness surgery benefit and for surgery done in a phys you said it would be done in the physician's office, is that correct?
[CUSTOMER][NEUTRAL] Yes.
[AGENT][NEUTRAL] OK, so that benefit is $125 per day, maximum of 2 days per calendar year per covered person.
[CUSTOMER][NEUTRAL] OK, I'm trying to write it down. OK, you said $125 per day, maximum of 2 days.
[AGENT][NEUTRAL] Sure.
[AGENT][NEUTRAL] Uh-huh.
[AGENT][NEUTRAL] Per calendar year per cover person.
[CUSTOMER][NEUTRAL] OK, and then what did you say about the limited benefit medical plan? You said something about accident.
[AGENT][NEUTRAL] Yes, and this is, this is.
[AGENT][NEUTRAL] Well, the benefit that would fall, this falls under accident and sickness. So it's related to an accident or sickness, the surgery benefit in a physician's office would be $125 per day and a max of, excuse me, max of 2 days per calendar year.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][POSITIVE] Alright, well I thank you for your help. Oh, OK, go ahead.
[AGENT][NEUTRAL] And then
[AGENT][NEUTRAL] Well, you're welcome, [PII], and I was just gonna let you know you may already have this information, but if um a claim is filed on this policy, once it has been processed, we do have a portal in which you should be able to check claim status, and the portal website for us is secured.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] [PII].
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] Mhm, yes, I am.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] All right. And is there, uh-huh.
[CUSTOMER][NEUTRAL] And what about
[CUSTOMER][NEUTRAL] What about office visits? Like if she come in just for non-surgery, just office visits.
[AGENT][NEUTRAL] For
[AGENT][NEUTRAL] Yes, ma'am. The office visit benefit on this policy is $50.
[AGENT][NEUTRAL] Per day, maximum of 4 days per calendar year per covered person.
[CUSTOMER][NEUTRAL] OK, so the office visit has to be an accident as well.
[AGENT][NEUTRAL] Accident and or sickness.
[CUSTOMER][NEUTRAL] Sickness, OK, got you. All right.
[AGENT][NEUTRAL] Mhm. So like if it was a wellness, that would not be, you know, this would have to be related to either an accident or a sickness for this benefit.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Alright, do you have a reference number, [PII]?
[AGENT][NEUTRAL] Sure, you would use my name along with today's date and pay my first initial to my last name is also [PII] if you need that.
[CUSTOMER][POSITIVE] OK alright thank you so much for your help.
[AGENT][POSITIVE] OK. Well, you are certainly welcome. So again, if that is all I can help you with, thank you for calling APL and I hope you have a great day.
[CUSTOMER][POSITIVE] OK thank you bye bye.
[AGENT][POSITIVE] You're welcome. Bye bye.