AccountId: 011433970860
ContactId: ecaf8a43-4bd7-4dcb-827e-298795beb604
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 522200 ms
Total Talk Time (AGENT): 212156 ms
Total Talk Time (CUSTOMER): 197559 ms
Interruptions: 2
Overall Sentiment: AGENT=1.3, CUSTOMER=0.6
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/01/22/ecaf8a43-4bd7-4dcb-827e-298795beb604_20250122T14:12_UTC.wav
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[AGENT][POSITIVE] Good morning. Thank you for calling APL. This is [PII]. How can I help you?
[CUSTOMER][NEUTRAL] Oh, hey, hi, this is [PII] calling from provider's office.
[AGENT][NEUTRAL] I'm sorry, what was your name?
[CUSTOMER][NEUTRAL] This is [PII].
[AGENT][NEUTRAL] [PII], is that correct?
[CUSTOMER][NEUTRAL] Uh, no, it's actually [PII].
[AGENT][POSITIVE] Oh, OK, [PII]. I'm very sorry about that. OK, and your callback number?
[CUSTOMER][NEUTRAL] Uh, sure. So the callback number will be [PII].
[AGENT][POSITIVE] Thank you. And how can I help you today, [PII]?
[CUSTOMER][NEUTRAL] Yeah, so before we proceed, I would like to inform you that this call is going to be recorded for training and quality purposes. Is that OK?
[AGENT][NEUTRAL] That is fine.
[AGENT][POSITIVE] And how can I help you today?
[CUSTOMER][NEUTRAL] So I'm calling you to ver
[CUSTOMER][NEUTRAL] Yeah, so I'm calling you to verify the eligibility and benefits for one member.
[AGENT][NEUTRAL] OK, you have one member to verify eligibility and benefits for, is that correct?
[CUSTOMER][NEUTRAL] Yes.
[AGENT][NEUTRAL] Yes, sir. I can help you with that. And what is your uh patient's policy number, please?
[CUSTOMER][NEUTRAL] So, the policy number.
[CUSTOMER][NEUTRAL] So, uh, as of now, I'm looking a card copy. You want policy, policy, policy number or the medical ID number?
[AGENT][NEUTRAL] Policy certificate policy.
[CUSTOMER][NEUTRAL] OK, OK. So the policy number is 02544684.
[AGENT][NEUTRAL] The last number was 4, is that correct?
[CUSTOMER][NEUTRAL] Uh, yeah, yeah. So, so the policy number is 025446884.
[AGENT][POSITIVE] Thank you.
[AGENT][NEUTRAL] OK, give me a couple of moments to get the member's information.
[CUSTOMER][NEUTRAL] Yep.
[AGENT][NEUTRAL] Hold up, please.
[CUSTOMER][NEUTRAL] Sure.
[CUSTOMER][POSITIVE] Sure, take your time.
[AGENT][POSITIVE] Thank you.
[AGENT][NEUTRAL] OK, and any information that I did provide for you today, Harsh would be a verification of benefits and not a guarantee of payment. What is your patient's name and their date of birth, please?
[CUSTOMER][NEUTRAL] Yeah, so my member name is [PII] and the date of birth is [PII].
[AGENT][POSITIVE] Thank you.
[AGENT][NEUTRAL] Mhm
[AGENT][NEUTRAL] Subscriber on this hospital indemnity limited benefit plan and this policy is active with an effective date of [PII].
[AGENT][NEUTRAL] And what type of benefit information are you needing on this limited benefit plan?
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Yeah, so can you please help me with the uh term, date, plan number, group name and group number?
[AGENT][NEUTRAL] The policy is active, so that means there is no term date at this time.
[AGENT][NEUTRAL] The group number is 70058.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] The name of the group is Morales Enterprises Inc.
[CUSTOMER][NEUTRAL] OK. So the name is Morales, M O R A L E S.
[AGENT][NEUTRAL] Correct. Enterprises, uh-huh, uh-huh. Inc for Incorporated INC.
[CUSTOMER][NEUTRAL] Enterprises. Is that right?
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Oh, OK. And is there any plan number you can help me with?
[AGENT][NEUTRAL] The policy number is the first number you gave me and I have the group number. That's the only two numbers.
[CUSTOMER][POSITIVE] OK. Wonderful, wonderful. Now, can you please tell me that uh is this patient uh subscriber or dependent on this plan?
[AGENT][NEUTRAL] And are you needing
[AGENT][NEUTRAL] Uh-huh.
[AGENT][NEUTRAL] Subscriber.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] And are you needing inpatient, outpatient or office benefits on this limited benefit plan?
[CUSTOMER][NEUTRAL] One moment.
[CUSTOMER][NEUTRAL] Yeah, I need office benefits like uh PCP co-pay, specialist co-pay, and co-insurance.
[AGENT][NEUTRAL] Or an office
[AGENT][NEUTRAL] And there is no co-pay. Yes, so there's no copay or co-insurance. We are not a major medical insurance company.
[AGENT][NEUTRAL] Again, this is a hospital indemnity limited benefit plan. So for outpatient accident and sickness.
[AGENT][NEUTRAL] The benefit for a physician's office is $50 per day and a maximum of 4 days per calendar year per covered person.
[CUSTOMER][NEUTRAL] I'm so sorry that uh you had given me that per day co-pay for PCP. Is that right?
[AGENT][NEUTRAL] There is no co-pay. No, sir, there is no co-pay. That is the, that is the benefit amount. Again, this is not major medical insurance.
[CUSTOMER][POSITIVE] Oh, I'm so sorry.
[CUSTOMER][NEUTRAL] So
[AGENT][NEUTRAL] It is a limited benefit plan that will pay specific dollar amounts.
[AGENT][NEUTRAL] For certain services. Mhm.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Uh, OK. Uh, is there any deductible for this plan?
[AGENT][NEGATIVE] There is not.
[CUSTOMER][NEUTRAL] OK. There is no deductible and there is
[CUSTOMER][NEUTRAL] Is that out of pocket? No, right?
[AGENT][NEUTRAL] No.
[CUSTOMER][NEUTRAL] OK. So, let me just reconfirm all the benefits you have given me that the insurance start date is [PII]. There is no end date. Group name is more or less, M O R A L E S Enterprises and the group number is 70058. This patient is subscriber. There is no co-pay, no specialist copay, no co-insurance. Individual deductible is also no, and the individual out of pocket is also no.
[CUSTOMER][NEUTRAL] Right?
[AGENT][POSITIVE] Correct.
[CUSTOMER][NEUTRAL] OK. Uh, can you just help me with your name and your last name initials.
[AGENT][NEUTRAL] Again, my name is [PII], first initial to last name, [PII]. You will use my name along with today's date [PII] as your call reference number.
[AGENT][NEUTRAL] And if you will end up filing a claim with APO once we have processed the claim.
[AGENT][NEUTRAL] Then you may check claim status by going to our portal at [PII].
[AGENT][NEUTRAL] And again, as I mentioned, I don't know if you repeated this portion, but for an.
[AGENT][NEUTRAL] Office visit related to accident or sickness, the benefit amount on this policy is $50 per day and a maximum of 4 days per calendar year.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK. So can you just help me, uh, can you just spell your first name for me?
[AGENT][NEUTRAL] Uh-huh.
[AGENT][NEUTRAL] It is [PII], [PII]
[CUSTOMER][NEUTRAL] OK. And the card reference number will be your first name and your last name initials with today's date, right?
[AGENT][POSITIVE] That is correct.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Uh, so the call reference number will be T R A C I S as in uh your last name initial 01222025. Correct?
[AGENT][POSITIVE] Correct.
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][POSITIVE] Thank you so much for this information and have a great day.
[AGENT][POSITIVE] Absolutely. I hope you have a great day too. That's all I can help you with, and thank you again, [PII] for calling APL.
[CUSTOMER][POSITIVE] Thank you so much bye bye.
[AGENT][POSITIVE] You're welcome. Bye bye.