AccountId: 011433970860
ContactId: dfdc316d-5478-4c12-9791-fa2b17604b6f
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 284029 ms
Total Talk Time (AGENT): 119044 ms
Total Talk Time (CUSTOMER): 67288 ms
Interruptions: 0
Overall Sentiment: AGENT=0.5, CUSTOMER=1.3
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/01/28/dfdc316d-5478-4c12-9791-fa2b17604b6f_20250128T14:36_UTC.wav
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[AGENT][POSITIVE] Thank you for calling APL. This is [PII]. How can I help you?
[CUSTOMER][NEUTRAL] Hi Ms. [PII], uh, my name is [PII]. I'm calling as a provider. I was trying to verify if a member had eligibility or benefits.
[AGENT][NEUTRAL] OK [PII], um, can I get a good callback number?
[CUSTOMER][NEUTRAL] Yeah, it's [PII].
[AGENT][NEUTRAL] OK, thank you, [PII]. Can I get the policy number?
[CUSTOMER][NEUTRAL] I actually don't have the policy number. I suppose her car or it seems her uh benefits are split between two plans and unfortunately she gave us the wrong one. I do have her social if that would help.
[AGENT][NEUTRAL] OK, can I get that social please?
[CUSTOMER][NEUTRAL] Yeah, it's uh [PII].
[AGENT][NEUTRAL] OK, what is the insured's first and last name, [PII]?
[CUSTOMER][NEUTRAL] First name is [PII], last name is [PII], and date of birth is [PII].
[AGENT][NEUTRAL] OK, let's see here.
[AGENT][NEUTRAL] And this is for medical.
[CUSTOMER][NEUTRAL] Uh yes, ma'am.
[AGENT][NEUTRAL] OK, give me just a second here, let's see.
[AGENT][NEUTRAL] Alright, bear with me.
[AGENT][NEUTRAL] OK, you said you're calling to check the eligibility, is that correct?
[CUSTOMER][NEUTRAL] Uh, yes, ma'am.
[AGENT][POSITIVE] OK, I can definitely take a look, so let me give you the policy number. Let's start there.
[CUSTOMER][POSITIVE] Oh, sure, thank you.
[AGENT][NEUTRAL] OK, so the policy number is 237.
[AGENT][NEUTRAL] 1130.
[AGENT][NEUTRAL] The policy was effective [PII] and currently still active.
[AGENT][NEUTRAL] And this is a hospital indemnity plan, so it mean it's a limited benefit plan.
[CUSTOMER][NEUTRAL] And does the plan have benefits for diagnostic imaging?
[AGENT][NEUTRAL] Uh, let's see here. Give me just a second. Let me actually go into the policy and we'll take a look there.
[AGENT][NEUTRAL] Um, so this will be a verification of benefits and not a guarantee of payment.
[AGENT][NEUTRAL] Um, let me get this pulled up.
[AGENT][NEUTRAL] OK, so on this policy diagnostic testing, um, they have medical imaging tests. It pays $100 per day with a maximum of 2 days per calendar year.
[AGENT][NEUTRAL] And then they have an advanced study follow up test that falls under the diagnostic testing benefit as well and it pays $25 per day with a maximum of 1 day per calendar year.
[AGENT][NEUTRAL] Do you know what type of tests they're having?
[CUSTOMER][NEUTRAL] Um, it's gonna be a CT scan.
[AGENT][NEUTRAL] OK, so that is going to, um, fall under that first benefit, the medical imaging test, so it would pay $100 per day with a maximum of 2 days per calendar year.
[CUSTOMER][POSITIVE] Got you.
[CUSTOMER][NEUTRAL] And does this plan utilize any networks?
[AGENT][NEGATIVE] It does not.
[CUSTOMER][NEUTRAL] And what would be the claim address?
[AGENT][NEUTRAL] It's gonna be PO [PII].
[AGENT][NEUTRAL] [PII]
[AGENT][NEUTRAL] [PII].
[AGENT][NEUTRAL] [PII].
[CUSTOMER][NEUTRAL] And what was that zip code again?
[AGENT][NEUTRAL] [PII].
[CUSTOMER][NEUTRAL] And would the claims be made out to APL?
[AGENT][POSITIVE] Yes sir, that is correct.
[CUSTOMER][NEUTRAL] Alrighty, well that should be everything that I would need. Is there a call reference number record list?
[AGENT][NEUTRAL] It's gonna be my name [PII] with the first [PII] to my last name.
[AGENT][NEUTRAL] [PII] and today's date, is there anything else that I can help you with today?
[CUSTOMER][POSITIVE] Alrighty.
[CUSTOMER][POSITIVE] No, [PII], I really appreciate your help. Have a nice rest of your day.
[AGENT][POSITIVE] OK, well thanks for calling API and I hope you have a great day.
[CUSTOMER][NEUTRAL] Mhm bye bye.
[AGENT][NEUTRAL] Bye bye.