AccountId: 011433970860
ContactId: e591138d-6204-4465-a732-b6c968c38d7b
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 271640 ms
Total Talk Time (AGENT): 136805 ms
Total Talk Time (CUSTOMER): 90371 ms
Interruptions: 0
Overall Sentiment: AGENT=1.1, CUSTOMER=0.7
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/02/19/e591138d-6204-4465-a732-b6c968c38d7b_20250219T15:50_UTC.wav
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[AGENT][POSITIVE] Good morning. Thank you for calling APL. My name is [PII]. How may I help you?
[CUSTOMER][NEUTRAL] Hi and I'm calling from North Bay Health. I was hoping to verify eligibility um for a patient and if they can be seen here.
[AGENT][POSITIVE] OK, well, I'll be more than happy to assist you um with the eligibility and the benefits. And may I have your name and a good contact number in case we're disconnected?
[CUSTOMER][NEUTRAL] Uh yes, it's [PII] and contact number is [PII].
[AGENT][NEUTRAL] Thank you for that. And may I have the member's policy number?
[CUSTOMER][NEUTRAL] Uh yes, policy is 02584924.
[AGENT][NEUTRAL] Thank you, hold on one moment.
[CUSTOMER][POSITIVE] Thank you.
[AGENT][POSITIVE] You're welcome.
[AGENT][NEUTRAL] And can you verify the member's first and last name and date of birth?
[CUSTOMER][NEUTRAL] Um, yes, it is Ms. [PII]. Date of birth [PII].
[AGENT][NEUTRAL] Thank you for that. And all the information provided is a verification of benefits, not a guarantee of payment. So let me see.
[CUSTOMER][NEUTRAL] OK uh so they're not.
[AGENT][NEUTRAL] All right, so this is a hospital indemnity policy, so it's a limited medical policy. Now, the hospital indemnity uh portion of the policy doesn't have like a network or a list of providers, but the PPO network through multiplan does. Um, we don't have access to the list of providers, but I can provide you with their phone number or website to check if you're in network.
[CUSTOMER][NEUTRAL] Do we need to log in?
[AGENT][NEGATIVE] Um, there's no login for the website.
[CUSTOMER][NEUTRAL] Oh, just to check, OK.
[AGENT][NEUTRAL] Uh-huh.
[CUSTOMER][NEUTRAL] OK, so you said a medical hospital indemnity plan. It sounds like they only have half hospital coverage, is that correct?
[AGENT][NEUTRAL] Um, let me see if it's only for hospitals. Some of them have additional benefits.
[CUSTOMER][NEUTRAL] So
[CUSTOMER][NEUTRAL] Oh, OK.
[AGENT][NEUTRAL] Um, so this one also has accident and sickness, um, surgery benefits, diagnostic testing.
[CUSTOMER][NEUTRAL] Yeah.
[AGENT][NEUTRAL] Um, and then there's a critical illness, um, rider that's also attached to it.
[AGENT][NEUTRAL] And just for the call, all the information provided is a verification of benefits, not a guarantee of payment.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK, and does she have an office with a copay?
[AGENT][NEUTRAL] Um, there's no co-pays for this policy because it's a limited medical policy.
[CUSTOMER][NEUTRAL] OK, um, what does that look like for the patient if they're scheduled for primary care services?
[AGENT][NEUTRAL] As in what would they pay when they come?
[CUSTOMER][NEUTRAL] Yes, so are they like limited to um like a certain amount of visits per year or?
[AGENT][NEUTRAL] Oh
[AGENT][NEUTRAL] So they don't really have like an office visit coverage on this policy. It's just what I, right, so it's only what I listed out for you.
[CUSTOMER][NEGATIVE] Oh, no professional.
[CUSTOMER][NEUTRAL] Oh.
[CUSTOMER][NEUTRAL] So when when you say that is is that.
[CUSTOMER][NEUTRAL] But not limited to like urgent care and hospital services, not outpatient primary care services?
[AGENT][NEUTRAL] So limited benefit just means it's a list of benefits that's uh that's selected for the policy and the policy will only cover those benefits. So for this one, it's hospital admission, confinement, the surgery, um, in a facility or physician office, diagnostic testing.
[AGENT][NEGATIVE] And then there's a critical illness rider for um with cancer.
[CUSTOMER][NEUTRAL] OK, so you did say physician office. Does that mean it she can be seen here and there wouldn't.
[AGENT][NEUTRAL] So that's the accident and sickness surgical benefits, so surgery in a physician's office.
[CUSTOMER][NEUTRAL] But it's not covered?
[CUSTOMER][POSITIVE] Surgery and if it oh my goodness, OK.
[CUSTOMER][NEUTRAL] Surgery in a physician office OK so no professional outpatient coverage. OK, that makes sense.
[AGENT][POSITIVE] Correct.
[CUSTOMER][NEUTRAL] OK, and [PII], can I please have a a reference number for the information?
[AGENT][NEUTRAL] Sure, so there's no call reference number, but you can use my name in today's date. The first initial to my last name is [PII].
[CUSTOMER][NEUTRAL] OK
[CUSTOMER][POSITIVE] OK, I appreciate it thank you so much.
[AGENT][POSITIVE] You're very welcome and thanks for calling [PII]. I hope you have a great day.
[CUSTOMER][POSITIVE] You too appreciate you thank you.
[AGENT][POSITIVE] You're welcome bye bye.
[CUSTOMER][NEUTRAL] Bye bye.