AccountId: 011433970860
ContactId: eb4749e2-bf50-4cab-a3b0-e8d40a03494e
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 199919 ms
Total Talk Time (AGENT): 103934 ms
Total Talk Time (CUSTOMER): 60013 ms
Interruptions: 1
Overall Sentiment: AGENT=0.9, CUSTOMER=0.5
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/04/01/eb4749e2-bf50-4cab-a3b0-e8d40a03494e_20250401T18:55_UTC.wav
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[AGENT][NEUTRAL] Thank you for calling APL. This is [PII]. How can I help you?
[CUSTOMER][NEUTRAL] Hi, I'm calling to verify um benefits for a patient please.
[AGENT][POSITIVE] Sure, I can check benefits for you. Uh, what was your name?
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] OK, [PII], can I get a good call back number from you in case we're disconnected?
[CUSTOMER][NEUTRAL] Sure it's [PII].
[AGENT][NEUTRAL] OK, thank you. And then do you have the policy number?
[CUSTOMER][NEUTRAL] Yes, let me grab that really quick hold on.
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] I have 02482879.
[AGENT][NEUTRAL] OK and then what was the name and date of birth for the member please?
[CUSTOMER][NEUTRAL] That is let me go back to that.
[CUSTOMER][NEUTRAL] So first name is [PII], last name [PII] [PII] Date of birth [PII].
[AGENT][NEUTRAL] Perfect, thank you for verifying that. Uh, so this policy is active. Effective date was [PII], and this is a limited indemnity medical plan. So essentially it pays a set dollar amount per covered procedure and office visit. If you'll give me one moment, I will get those benefits pulled up here.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] OK. And what kinds of benefits were we needing to take a look at, [PII]?
[CUSTOMER][NEUTRAL] Uh, dermatology office visit.
[AGENT][NEUTRAL] OK. And of course, I will let you know verification of coverage is not a guarantee of payment for claims. Uh, so this policy does not have
[AGENT][NEUTRAL] Well, let's see. I think that would be considered a specialist. I don't believe they would have uh any coverage for that. Um, no. So, uh, he does have benefits for physician's office, um, but I don't believe that would fall under that category as that is in regard to an accident or sickness as well. So it doesn't look like he would have benefits for a dermatology, uh, visit.
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] What do you
[CUSTOMER][NEUTRAL] So only like if you would go to like a primary physician?
[AGENT][NEUTRAL] Yeah, he has, again, these policies are very specific and limited, um, so he's got, you know, hospital benefits, intensive care, um, and then several outpatient, including emergency room, urgent care, uh, and then physician's office or physical therapy. That's the extent of the coverage for this policy.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Perfect. OK, I will let him know because I guess he was a little confused. OK, I will go ahead and let the patient know.
[AGENT][NEGATIVE] Sure, and no these kinds of plans are pretty confusing.
[CUSTOMER][NEUTRAL] Yeah.
[AGENT][NEUTRAL] Alright, did you have any other questions for me, [PII]?
[CUSTOMER][POSITIVE] All right thank you so much.
[CUSTOMER][NEUTRAL] Um, no, just I just wanted to make sure because I was unclear about the insurance as well.
[AGENT][POSITIVE] Of course, absolutely, well I appreciate you calling have a great rest of your day.
[CUSTOMER][POSITIVE] Thank you you too.
[AGENT][POSITIVE] Thank you. Bye bye.