AccountId: 011433970860
ContactId: e80c7a1b-a07f-4146-b465-d754e6940ab2
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 427369 ms
Total Talk Time (AGENT): 167152 ms
Total Talk Time (CUSTOMER): 215905 ms
Interruptions: 6
Overall Sentiment: AGENT=0.1, CUSTOMER=-0.1
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/03/24/e80c7a1b-a07f-4146-b465-d754e6940ab2_20250324T14:30_UTC.wav
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[AGENT][NEUTRAL] Thank you for calling APL. This is [PII]. How may I help you?
[CUSTOMER][NEUTRAL] Yes ma'am, I was calling because I need to verify patients benefits. I was not sure which option to push because we're an orthopedic clinic, um, and I'm just a scheduler. My insurance department said they were too busy to call so it's me. I'm here.
[AGENT][NEUTRAL] Uh-huh.
[AGENT][NEUTRAL] OK.
[AGENT][POSITIVE] OK, that's fine. I can definitely help you with the benefits and what is your, your name, your name and your callback number?
[CUSTOMER][POSITIVE] Thank you.
[CUSTOMER][NEUTRAL] Uh, my name is [PII]. Uh, my callback number is [PII].
[CUSTOMER][NEUTRAL] Um, my [PII] is my direct line.
[AGENT][NEUTRAL] OK, thank you, [PII]. And then can you give me the patient's name, date of birth, and policy number?
[CUSTOMER][NEUTRAL] Yes, um, it is [PII]
[CUSTOMER][NEUTRAL] Uh, for first name, last name [PII], so it should spell just [PII] or something like that.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Um, date of birth is, um,
[CUSTOMER][NEUTRAL] [PII], so, uh, the [PII].
[AGENT][NEUTRAL] Thank you. And then what is the um policy number?
[CUSTOMER][NEUTRAL] And let's see.
[CUSTOMER][NEUTRAL] Policy number.
[CUSTOMER][NEUTRAL] Let me get in here. OK, uh, 02519757.
[AGENT][NEUTRAL] OK, let me look that up real quick.
[CUSTOMER][NEUTRAL] Same reason for cancellation?
[CUSTOMER][NEUTRAL] OK, I'll go ahead
[CUSTOMER][NEUTRAL] I'll put that in this because it does go as a note.
[AGENT][NEUTRAL] OK, I do show that [PII] does have an active policy and her effective date is [PII].
[CUSTOMER][NEUTRAL] Yes ma'am, so it's the same.
[CUSTOMER][NEUTRAL] it would be the same.
[CUSTOMER][NEGATIVE] goes down
[CUSTOMER][NEGATIVE] The same thing canceling or rescheduling.
[AGENT][NEUTRAL] And this is just to verify her benefits. It's not a guarantee of payment. She has a hospital indemnity plan.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] And as soon as my computer pulls it up, um.
[AGENT][NEUTRAL] The hospital indemnity plan is a limited plan that helps with um hospital confinement. So, if she goes in the hospital, um, it pays one time a year, um.
[CUSTOMER][NEUTRAL] Bye
[CUSTOMER][NEUTRAL] So
[AGENT][NEUTRAL] Of $500. And then she has a daily hospital confinement benefit of $30. Um, she also has, um,
[AGENT][NEUTRAL] An outpatient, OK, let's see what this is. Outpatient sickness benefit rider for sickness that pays $25.
[CUSTOMER][NEUTRAL] I
[AGENT][NEUTRAL] Um,
[AGENT][NEUTRAL] She has an emergency room accident rider that pays a maximum of $300. She gets uh
[AGENT][NEUTRAL] $100 per visit, so she gets 3 visits per year.
[AGENT][POSITIVE] And then she also has a prescription benefit.
[AGENT][NEUTRAL] That helps pay $25.
[CUSTOMER][NEUTRAL] Yes ma'am like he already
[CUSTOMER][NEUTRAL] It it automatically just sends it again.
[AGENT][NEUTRAL] So it's a very limited policy.
[CUSTOMER][NEUTRAL] Yeah, so for us, so we're just a uh like a specialty clinic for like orthopedic specialty for um.
[CUSTOMER][NEUTRAL] So [PII] is saying they have a, a broken toe, um, to come to us, um.
[AGENT][NEUTRAL] Uh-huh.
[CUSTOMER][NEUTRAL] None of that would be covered I guess.
[AGENT][NEUTRAL] Let me look I'm gonna pull up per actually policy certificate and see if there's anything that will help with that.
[CUSTOMER][NEUTRAL] Yeah. I just don't know what that would fall. Yeah.
[CUSTOMER][NEUTRAL] Um-hum.
[AGENT][NEUTRAL] It's gonna be a moment while my computer loads it.
[CUSTOMER][NEUTRAL] Yeah, no, you're fine.
[CUSTOMER][NEUTRAL] What type of insurance?
[CUSTOMER][NEUTRAL] We're not providers for any adult Medicaid.
[CUSTOMER][NEGATIVE] Not with us.
[AGENT][NEUTRAL] Of course it's gonna take a moment for the computer to load it up.
[CUSTOMER][NEUTRAL] Mhm that no that's OK.
[CUSTOMER][NEUTRAL] I have an appointment with us. It might be memorial group orthopedic.
[AGENT][NEUTRAL] OK, let's see if she has anything.
[CUSTOMER][NEUTRAL] Yeah
[CUSTOMER][NEUTRAL] No, we're the center for orthopedics.
[CUSTOMER][NEUTRAL] Yeah
[CUSTOMER][POSITIVE] Thank you for calling, ma'am. You're welcome.
[AGENT][NEUTRAL] The only thing that may help would be the outpatients uh.
[CUSTOMER][NEUTRAL] Appointment that I have the patient's date of birth.
[AGENT][NEGATIVE] No, that's not gonna help cause it specifically says sickness and not injury.
[CUSTOMER][NEUTRAL] Yeah.
[AGENT][NEGATIVE] No, it doesn't look like it's gonna help with anything for outpatient unless it was a sickness.
[CUSTOMER][NEUTRAL] Mhm
[CUSTOMER][NEUTRAL] Yeah, I'm wondering if that's why so they said they've been able to go to like urgent care and it was covered. I'm wondering if that's why.
[CUSTOMER][NEUTRAL] Um, so when I call him back and let them know um that it wouldn't be covered, that would be an easier way to explain that like our urgent care.
[AGENT][NEUTRAL] Right.
[CUSTOMER][NEUTRAL] You know it's like a.
[CUSTOMER][NEUTRAL] Uh, I don't know, like an outpatient type thing, and, and this is not, this is like a, a, a private like a.
[AGENT][POSITIVE] Right, that's correct.
[CUSTOMER][NEUTRAL] A private business, OK.
[CUSTOMER][NEUTRAL] Alrighty well I'll let them know if they wanna come they can be self pay um but they wouldn't have any um like out of network benefits or anything here unless they have any out of network benefits.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] Yes, unless she has something else.
[CUSTOMER][NEUTRAL] But um
[CUSTOMER][NEUTRAL] Yeah alrighty well I will let them know.
[AGENT][NEUTRAL] [PII], what's the name of the facility again you're calling from?
[CUSTOMER][NEUTRAL] Um, so we're called, um, the Center for Orthopedics.
[AGENT][NEUTRAL] Now if she had to go inpatient for surgery.
[CUSTOMER][NEUTRAL] Mhm, they would cover like hospital yeah um but just like her regular office visits here they would she would just have to pay OK alrighty well I will let them know.
[AGENT][NEUTRAL] It would help her for that. Mm.
[AGENT][NEUTRAL] Right.
[AGENT][NEUTRAL] Right.
[AGENT][NEUTRAL] OK. Is there anything else, Ms. [PII], I can help you with?
[CUSTOMER][NEUTRAL] No, that's it.
[AGENT][POSITIVE] Alright well you have a wonderful week and thank you for calling APL.
[CUSTOMER][POSITIVE] OK thanks alright bye bye.
[AGENT][NEUTRAL] Bye-bye.