AccountId: 011433970860
ContactId: e61783a7-45ea-49e1-9dac-d43067e277f9
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 384589 ms
Total Talk Time (AGENT): 168996 ms
Total Talk Time (CUSTOMER): 100429 ms
Interruptions: 0
Overall Sentiment: AGENT=2.1, CUSTOMER=0.4
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/01/08/e61783a7-45ea-49e1-9dac-d43067e277f9_20250108T16:13_UTC.wav
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[AGENT][NEUTRAL] Hi, thank you for calling APL. This is [PII]. How can I help you today?
[CUSTOMER][NEUTRAL] Um, yes, ma'am. I'm calling from Benville Women's Services, and I need to, um, verify eligibility and benefits on patients.
[AGENT][POSITIVE] Yeah, I'd love to help you with some eligibility and benefits today and I'm so sorry, but can I get your name one more time please?
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] [PII], thank you, ma'am. And do you mind if I also get a good callback number?
[CUSTOMER][NEUTRAL] It's [PII].
[AGENT][POSITIVE] Wonderful, thank you and your member's policy number?
[CUSTOMER][NEUTRAL] 02.
[CUSTOMER][NEUTRAL] 4
[CUSTOMER][NEUTRAL] 3
[CUSTOMER][NEUTRAL] Hold on 024.
[AGENT][POSITIVE] No worries.
[CUSTOMER][NEUTRAL] 858 9
[AGENT][POSITIVE] Perfect, give me 1 2nd to get that pulled up.
[AGENT][NEUTRAL] Can you verify for me, pretty please, your patient's first and last name and date of birth?
[CUSTOMER][NEUTRAL] [PII].
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] All right, unfortunately, I'm not seeing that under this policy number. It looks like I have 243-858-9, is that correct?
[CUSTOMER][NEUTRAL] Um, it, there's a 0, it's 02.
[CUSTOMER][NEUTRAL] 438589
[AGENT][NEUTRAL] OK, I'm sorry, that was my mistake. I do see Ms. [PII] here and if you could verify for her, for me again the date of birth if you said it already, I'm sorry.
[CUSTOMER][NEUTRAL] Yes ma'am. [PII].
[AGENT][POSITIVE] Perfect.
[AGENT][NEUTRAL] And it looks like your patient is current and active with this policy. The effective date on it is [PII].
[AGENT][NEUTRAL] And
[AGENT][NEUTRAL] This is one of our limited hospital indemnity policies, and you said you're needing some benefits, is that correct? I cannot talk. Is that correct?
[CUSTOMER][NEUTRAL] Yes, um, she, we are.
[AGENT][POSITIVE] Thank you.
[CUSTOMER][NEUTRAL] I'm sorry?
[AGENT][POSITIVE] Oh, I said thank you. I'm sorry.
[CUSTOMER][NEUTRAL] It's OK, uh, we are her OBGYN and she's here for her well woman exam.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] I'm just pulling up that benefit screen real quick.
[AGENT][NEUTRAL] And while I'm waiting for those benefits to come up, I do want to let you know that any information I give you over the phone today is just a verification of coverage and not a guarantee of payment.
[CUSTOMER][NEUTRAL] Yes ma'am.
[AGENT][POSITIVE] Thank you.
[AGENT][NEUTRAL] All right, it looks like your patient has a wellness diagnostic test benefit, so it looks like it says wellness exam and or test benefit. Um, she's eligible for up to $75 per.
[AGENT][NEUTRAL] Test and it looks like the maximum benefit for that is $250 per person.
[CUSTOMER][NEUTRAL] So it only pays for um.
[CUSTOMER][NEUTRAL] Like I guess you'll get a pap smear today.
[CUSTOMER][NEUTRAL] So it only pays for tests that she does it doesn't pay anything towards the office visit?
[AGENT][NEUTRAL] Um, it says that it covers wellness exam and test benefits. She also has another benefit for diagnostic testing. I'm not sure if the path would fall underneath that, but the diagnostic testing benefit is $250 per test with a maximum of the $250 per calendar year.
[CUSTOMER][POSITIVE] Good
[CUSTOMER][NEGATIVE] OK, I'm, I'm not getting them.
[CUSTOMER][NEUTRAL] Understanding of um.
[CUSTOMER][NEUTRAL] How, how, I, I mean, I understand you're saying 75 up to 250, but.
[CUSTOMER][NEUTRAL] What is the benefit for the actual office visits?
[AGENT][NEUTRAL] I'm not showing as far as like the consultation physician fee sort of thing any benefit on here. This is a limited hospital indemnity policy.
[CUSTOMER][NEUTRAL] OK, so it's not gonna pay anything towards her office visit.
[AGENT][NEUTRAL] I mean, I, we can't like they say we can't pay claims over the phone so I can't ever guarantee anything's paid or not. It just has to come through on the um on the claim form but I'm not showing any benefits that would just cover like the initial office visit.
[CUSTOMER][NEUTRAL] OK, because see the tests are not processed here in our office they're sent out to, um, like Labor.
[CUSTOMER][NEUTRAL] So they're the ones that would actually receive the payment for processing the test.
[CUSTOMER][NEUTRAL] Our main charge here would be for the office visit that's why I was asking.
[AGENT][NEUTRAL] OK, yeah, so I'm not, I, I don't believe she has any benefits as far as
[AGENT][NEUTRAL] The
[AGENT][NEUTRAL] The office goes.
[CUSTOMER][NEUTRAL] OK, and what was your name?
[AGENT][NEUTRAL] Yes, my name is [PII].
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][POSITIVE] Alright, thank you.
[AGENT][POSITIVE] Yeah, it's my pleasure and thank you so much Ms. [PII] for calling APL. I hope you have a wonderful day.
[CUSTOMER][POSITIVE] You too thanks.
[AGENT][POSITIVE] My pleasure. Bye bye.