AccountId: 011433970860
ContactId: e6a1f216-a4f9-443e-adac-fd08aae9f914
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 409130 ms
Total Talk Time (AGENT): 177069 ms
Total Talk Time (CUSTOMER): 125254 ms
Interruptions: 1
Overall Sentiment: AGENT=0, CUSTOMER=0.6
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/02/24/e6a1f216-a4f9-443e-adac-fd08aae9f914_20250224T20:40_UTC.wav
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[AGENT][NEUTRAL] Good afternoon, thank you for calling APL. This is [PII]. How may I assist you?
[CUSTOMER][NEUTRAL] Good afternoon. I am calling to verify benefits for our patient.
[AGENT][POSITIVE] OK, sure. I can assist you with benefits. And may I have your name?
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] And Ms. [PII], may I have a callback number just in case we get disconnected?
[CUSTOMER][NEUTRAL] Yes. Um, let me have [PII].
[AGENT][NEUTRAL] OK. And you're calling from which uh facility or provider?
[CUSTOMER][NEUTRAL] Advent Health Hospital.
[AGENT][NEUTRAL] OK. Thank you. And may I have the patient's policy number, Miss [PII]?
[CUSTOMER][NEUTRAL] Yes, it is.
[CUSTOMER][NEUTRAL] Um,
[CUSTOMER][NEUTRAL] 02538271.
[AGENT][NEUTRAL] All right. And what's the name and date of birth of the patient?
[CUSTOMER][NEUTRAL] [PII], um [PII].
[AGENT][NEUTRAL] OK. Thank you. All right. And what type of service is being rendered?
[CUSTOMER][NEUTRAL] Uh, emergency services.
[AGENT][NEUTRAL] Yeah, OK.
[AGENT][NEUTRAL] Alright, and before I give you any benefit information, I need to let you know that this is not a guarantee of payment, just a verification of coverage and that's just a disclaimer and let me see what we cover. One moment.
[CUSTOMER][NEUTRAL] Yeah.
[AGENT][NEUTRAL] Mhm.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] Mm.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] OK, bear with me, um, let me pull the certificate. I don't see the ER visit here. Um, let me see if I can find that.
[CUSTOMER][NEUTRAL] I just wanna confirm that this is actually active for a date of service.
[AGENT][NEUTRAL] What is the data service?
[CUSTOMER][NEUTRAL] It's the uh [PII].
[AGENT][NEUTRAL] OK, yeah, it, it is active, um, it was active [PII] and it is active at the moment.
[CUSTOMER][NEUTRAL] And do you have a termination date?
[AGENT][NEUTRAL] I don't have a termination date at this moment.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] And um what is the exact insurance plan name?
[AGENT][NEUTRAL] Mhm.
[AGENT][NEUTRAL] Um, this particular policy, uh, the insurance plan, this is a hospital indemnity plan. That is the, the title is the Hospital indemnity plan. It is a limited policy.
[AGENT][NEUTRAL] American public life.
[AGENT][NEGATIVE] And limited policy. Mhm. And I, I, I don't see any benefit for ER Miss [PII]. Looks like it's only for admission, confinement, intensive care, and rehabilitation only.
[CUSTOMER][NEUTRAL] Limited policy.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK. And what about um the claim address? Can I confirm that just in case?
[AGENT][NEUTRAL] Mhm. Yes, go ahead.
[CUSTOMER][NEUTRAL] Can you actually um verify that for me?
[AGENT][NEUTRAL] I give it to you. OK, sure. That is um [PII].
[AGENT][NEUTRAL] And the zip code is [PII].
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][POSITIVE] Awesome. OK. Is this like a um coverage that is priced at a network?
[AGENT][NEGATIVE] No, this one doesn't have any network um.
[AGENT][NEGATIVE] No, this one doesn't have any network. Mhm.
[CUSTOMER][NEUTRAL] OK. So, or is it billed?
[CUSTOMER][NEUTRAL] Mm.
[AGENT][NEUTRAL] Mm, no, not this one.
[CUSTOMER][NEUTRAL] Like at a limited benefit you said either at a limited benefit or reference based pricing?
[AGENT][NEUTRAL] This is a limited.
[AGENT][NEUTRAL] Um, this is a limited policy, but it's an indemnity plan. So it pays like a flat amount based on the benefits of the policy. Um, so it doesn't have any discounts. It's not repriced for any discounts. This one just pays that flat amount and that's all.
[CUSTOMER][NEUTRAL] Pays a flat amount, OK.
[AGENT][NEUTRAL] Mhm, yes, it's an indemnity policy so it's an indemnity amount.
[CUSTOMER][NEUTRAL] Got it.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] And then um.
[CUSTOMER][NEUTRAL] Um
[CUSTOMER][NEUTRAL] I think I have all I needed. Can I have a reference, a call reference number in your name, please?
[AGENT][NEUTRAL] OK. Sure. We don't have reference numbers, but you can use my name in today's date. Um, my name is [PII], that's [PII]. Last initial is [PII].
[CUSTOMER][NEUTRAL] OK, and today's date, OK.
[AGENT][NEUTRAL] Mm
[AGENT][NEUTRAL] Yes.
[CUSTOMER][NEUTRAL] OK, let me just double check something.
[AGENT][NEUTRAL] OK, sure, yes.
[CUSTOMER][NEUTRAL] OK, so.
[CUSTOMER][NEUTRAL] I think that's actually.
[CUSTOMER][POSITIVE] And I really appreciate your help. I think I got everything.
[AGENT][NEUTRAL] Welcome.
[CUSTOMER][NEUTRAL] I need it so.
[AGENT][NEUTRAL] OK.
[CUSTOMER][POSITIVE] OK. Thank you for your time.
[AGENT][POSITIVE] All right, well thanks. You're welcome and thank you for calling ATL. Have a good afternoon, Miss [PII].
[CUSTOMER][POSITIVE] Bye-bye. Thanks.
[AGENT][POSITIVE] You welcome.