AccountId: 011433970860
ContactId: ec083cbe-33ad-4c3a-8023-e319f6968f78
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 403269 ms
Total Talk Time (AGENT): 229785 ms
Total Talk Time (CUSTOMER): 96301 ms
Interruptions: 2
Overall Sentiment: AGENT=0.5, CUSTOMER=1
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/01/06/ec083cbe-33ad-4c3a-8023-e319f6968f78_20250106T15:07_UTC.wav
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[AGENT][NEUTRAL] Good morning. Thank you for calling APL. This is [PII] speaking. How can I help you?
[CUSTOMER][NEUTRAL] Hey [PII], how you doing?
[AGENT][POSITIVE] I'm doing well thank you how are you?
[CUSTOMER][NEUTRAL] OK, thanks for asking. This is [PII] in [PII]. I have a provider on on the phone by the name of [PII]. He's calling to verify HI benefits for a member. He said that the member came in for an ER visit, however, ended up getting a surgery to remove a corrupt pending.
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Let me give you the policy number. Let me know when you're ready for it.
[AGENT][NEUTRAL] Go ahead.
[CUSTOMER][NEUTRAL] It is 253-827-1. That's 253-827-1.
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] I'm [PII].
[AGENT][NEUTRAL] And his his name is [PII].
[CUSTOMER][NEUTRAL] Yes. And the callback number? Go ahead.
[AGENT][NEUTRAL] And he's wanting eligibility?
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] OK
[CUSTOMER][NEUTRAL] And call back number is [PII].
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] 01 moment.
[AGENT][POSITIVE] Thank you [PII].
[CUSTOMER][POSITIVE] You're welcome.
[CUSTOMER][POSITIVE] Hello [PII], I'm gonna transfer you over to someone that can better assist you. Thanks for calling APL and have a great day.
[AGENT][NEUTRAL] Hi [PII].
[AGENT][NEUTRAL] Can you hear me OK? Hello. My name is [PII]
[CUSTOMER][NEUTRAL] Hi there?
[CUSTOMER][NEUTRAL] Yes.
[CUSTOMER][NEUTRAL] OK.
[AGENT][POSITIVE] Last initial is [PII].
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] And you're needing eligibility for um Mr. [PII]?
[CUSTOMER][POSITIVE] That's correct.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] And um did you want benefits as well?
[CUSTOMER][NEUTRAL] Um, yeah.
[AGENT][NEUTRAL] OK, and I believe [PII] said that he came through the emergency room and had surgery, is that correct?
[CUSTOMER][NEUTRAL] Yeah, he had his appendix removed.
[AGENT][NEUTRAL] OK, so just give me one moment to pull up the policy just to let you know it is a verification of coverage only and not a guarantee of payment.
[CUSTOMER][NEUTRAL] OK
[AGENT][NEUTRAL] OK, so just bear with me for one moment and uh was [PII] able to provide you that eligibility date?
[CUSTOMER][NEUTRAL] And no
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] But, but, but they were seen on the [PII].
[AGENT][NEUTRAL] [PII], OK.
[CUSTOMER][NEUTRAL] Yeah
[AGENT][NEUTRAL] Alright.
[AGENT][NEUTRAL] If you don't mind, I'm gonna have you verify the date of birth for Mr. [PII].
[CUSTOMER][NEUTRAL] Yeah, [PII].
[AGENT][POSITIVE] OK, thank you.
[AGENT][NEUTRAL] Just wanna make sure I have the correct person and I'm sorry, can you tell me uh the name of the facility you're calling from [PII]?
[CUSTOMER][NEUTRAL] Sun Suncoast Surgical Associate.
[AGENT][POSITIVE] Thank you.
[AGENT][NEUTRAL] OK, so this policy is a limited medical hospital indemnity plan.
[AGENT][NEUTRAL] And what that means is just as limited medical benefits.
[AGENT][NEUTRAL] Now that effective date is [PII].
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] And then I do show eligibility let me just check that real quick.
[AGENT][NEUTRAL] And you said it was [PII], is that right?
[CUSTOMER][NEUTRAL] Yes
[AGENT][NEUTRAL] OK, so I do show the eligible, uh, eligibility for December, um, under this plan, and again it's limited medical hospital and so let me just check those benefits for you.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] Now it does appear that this policy is um does not have any outpatient benefits. Now was the patient admitted or it was done outpatient?
[CUSTOMER][NEUTRAL] It's an emergency.
[AGENT][NEUTRAL] Yeah, through the emergency room, but was he admitted to the hospital?
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] Yeah
[AGENT][NEUTRAL] OK, so, um, again, uh, this policy does have limited medical benefits. I do not see any outpatient benefit, but for that inpatient, uh, inpatient benefit, that hospital admission, which would be their first hospitalization, uh, for the calendar year, they would be allowed a $2000 benefit.
[AGENT][NEUTRAL] And that's one day per person?
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] Uh, per calendar year and that confinement benefit, which is a daily, uh, confinement benefit, it's a per day, uh, maximum of $100 and they're allowed up to 30 days.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEGATIVE] And I do not show any uh surgical benefit again under this policy. It is strictly inpatient only.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] Just let me double check that and I could tell you, and you said it was December, so let me just make sure that benefit uh for the hospital stay, uh is not exhausted for [PII].
[CUSTOMER][NEUTRAL] OK, do you, do you have the address I would send the claims to?
[AGENT][POSITIVE] I do, yes.
[AGENT][NEUTRAL] OK, so I do show that for [PII] that hospital admission benefit was uh.
[AGENT][NEUTRAL] Was used
[AGENT][NEUTRAL] So, um, that benefit is exhausted for the calendar year.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] Let me just, just give me one moment.
[AGENT][NEUTRAL] OK, so I do show.
[AGENT][NEUTRAL] Was he admitted on [PII]?
[CUSTOMER][NEUTRAL] Yes, he was.
[AGENT][NEUTRAL] OK, I actually show that uh yeah that benefit was exhausted for that data service for the inpatient stay.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Well, we'll still have to.
[AGENT][NEUTRAL] Send the claim, right, OK, so you're.
[CUSTOMER][NEUTRAL] um, you send the claim, yeah.
[AGENT][NEUTRAL] Yes, of course, so the claims mailing address [PII] is gonna be uh APL.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Yeah.
[AGENT][NEUTRAL] And it's [PII].
[AGENT][NEUTRAL] [PII].
[AGENT][NEUTRAL] And it's [PII].
[AGENT][NEUTRAL] [PII].
[AGENT][NEUTRAL] And the zip code is [PII].
[AGENT][NEUTRAL] [PII].
[CUSTOMER][NEUTRAL] I
[CUSTOMER][NEUTRAL] Uh
[CUSTOMER][POSITIVE] OK, that's great.
[AGENT][NEUTRAL] Did you have any other questions?
[CUSTOMER][POSITIVE] Do, do you have a tel oh this telephone number, so I'll do so but that's everything thank you for your help.
[AGENT][POSITIVE] You're welcome, [PII]. Thank you so much for calling APL. I hope you have a great rest of your day.
[CUSTOMER][POSITIVE] Thank you have a great one. Goodbye.
[AGENT][NEUTRAL] Alright, bye bye.