AccountId: 011433970860
ContactId: ebd70317-27c0-4a22-ab16-34db7a580136
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 196949 ms
Total Talk Time (AGENT): 69504 ms
Total Talk Time (CUSTOMER): 63661 ms
Interruptions: 0
Overall Sentiment: AGENT=1, CUSTOMER=0.7
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/05/08/ebd70317-27c0-4a22-ab16-34db7a580136_20250508T16:01_UTC.wav
--------------------------------------------
[AGENT][POSITIVE] Thanks for calling APL. This is [PII]. How can I help you?
[CUSTOMER][NEUTRAL] Uh, hi, this is [PII] calling from my doctor now. Um, we're a primary care provider. I just called trying to verify, um, eligibility for a patient, um, and I was told, uh, it looks like this particular member, this particular defendant is not covered. I just wanted to uh double check that and then also verify if they have medical coverage just in general on the plan.
[AGENT][NEUTRAL] OK. Do you have the policy number?
[CUSTOMER][NEUTRAL] Yeah, yeah, that is going to be 025993997.
[AGENT][NEUTRAL] OK. And what was the patient name and date of birth?
[CUSTOMER][NEUTRAL] Uh, that's [PII], uh, DO be [PII].
[AGENT][NEUTRAL] OK, yeah, it looks like you just called. Um, I don't have that name. I have the date of birth and that last name, but that's not the name that goes that we have on file.
[CUSTOMER][NEUTRAL] Yeah.
[AGENT][NEUTRAL] Is there another name potentially or?
[CUSTOMER][NEUTRAL] Mm, OK.
[CUSTOMER][NEUTRAL] Uh, let me double check one moment.
[AGENT][NEUTRAL] Got a female.
[AGENT][NEUTRAL] Member, but I don't, it's, that's not the name.
[CUSTOMER][NEUTRAL] Uh, OK, let me take a look.
[CUSTOMER][NEUTRAL] Uh, [PII].
[AGENT][POSITIVE] Yes, I have that. Yes, I do have that.
[CUSTOMER][NEUTRAL] OK, OK, OK, and they are covered and are they covered for medical benefits?
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] Um, let me see what the policy offers. Um, they're effective [PII] currently active.
[AGENT][NEUTRAL] And then let me get that policy pulled up. One moment.
[AGENT][NEUTRAL] And anything I quote is not a guarantee of payment, just a basic outline of the policy.
[AGENT][NEUTRAL] Uh, let's see.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] Um, so this is a supplemental hospital indemnity plan. It's a limited supplemental plan for physician's office visit, it pays a maximum of $75 per day, and they get a max of 6 visits per calendar year.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Yeah, and then do you happen to know if our provider would be in network?
[AGENT][NEGATIVE] Uh, there's no network. It's not applicable since it's supplemental.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][POSITIVE] I got you.
[CUSTOMER][NEUTRAL] OK, and then what was your name?
[AGENT][NEUTRAL] Uh, my name is [PII].
[CUSTOMER][NEUTRAL] Got you and do you have a reference number?
[AGENT][NEUTRAL] Uh just my name and today's date.
[CUSTOMER][POSITIVE] Got you.
[CUSTOMER][NEUTRAL] And do you have the last initial of your last name?
[AGENT][NEUTRAL] That's [PII].
[CUSTOMER][NEUTRAL] OK, and you said it's a 7 it pays a maximum of $75.
[AGENT][POSITIVE] That's correct, yes.
[CUSTOMER][POSITIVE] OK, all right, thank you so much.
[AGENT][POSITIVE] Thank you for calling APL. Have a great day.
[CUSTOMER][NEUTRAL] You too bye bye.