AccountId: 011433970860
ContactId: ed305c6e-5a81-42a0-b2ce-b98578e89a76
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 403160 ms
Total Talk Time (AGENT): 131479 ms
Total Talk Time (CUSTOMER): 126328 ms
Interruptions: 2
Overall Sentiment: AGENT=0.3, CUSTOMER=0.3
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/04/01/ed305c6e-5a81-42a0-b2ce-b98578e89a76_20250401T15:49_UTC.wav
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[AGENT][NEUTRAL] Thank you for calling APL. This is [PII]. How can I help you?
[CUSTOMER][NEUTRAL] Yes [PII], my name is [PII]. I'm calling from Lewisville Medical Center and I have a patient in the office and I'm trying to verify um eligibility.
[AGENT][NEUTRAL] OK, I'm happy to check on eligibility, [PII]. Do you have their policy number?
[CUSTOMER][NEUTRAL] Yes, it's 25 excuse me 02539248.
[AGENT][POSITIVE] Alright, thank you for that. Let me pull this up here.
[AGENT][NEUTRAL] And do you have a good callback number in case we're disconnected?
[CUSTOMER][NEUTRAL] Yes ma'am, it's [PII].
[CUSTOMER][NEUTRAL] [PII]
[AGENT][NEUTRAL] And the patient name and date of birth?
[CUSTOMER][NEUTRAL] [PII].
[CUSTOMER][NEUTRAL] Date of birth is [PII].
[AGENT][NEUTRAL] Thank you. So the patient is active. The effective date on this is [PII].
[CUSTOMER][NEUTRAL] Expect
[CUSTOMER][NEUTRAL] [PII].
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] Mhm, yes, ma'am.
[CUSTOMER][NEUTRAL] Is that what you said? OK, does he have a copay or anything?
[AGENT][NEUTRAL] Uh-huh.
[AGENT][NEUTRAL] So this is a limited benefit hospital indemnity plan. It's just gonna pay a set amount depending upon what the patient's being seen for. Is it an office visit?
[CUSTOMER][NEUTRAL] It's an office is it doctor's office.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] So their outpatient office visit, it looks like the plan pays $50 towards the office visit.
[AGENT][NEUTRAL] And they're allowed 4 in a calendar year.
[CUSTOMER][NEUTRAL] So he doesn't have a copay. It's just he paid $50 towards um what his visit is.
[AGENT][NEUTRAL] Mhm. The plan pays at $50 towards whatever the fee is for the visit. Yes, ma'am.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Um
[CUSTOMER][NEUTRAL] So what is the payer ID number?
[CUSTOMER][NEUTRAL] Do you have that?
[AGENT][NEUTRAL] Uh, let me double check one moment.
[AGENT][NEUTRAL] Let me see what this group is. Give me just.
[AGENT][NEUTRAL] Oh
[AGENT][NEUTRAL] Yeah.
[CUSTOMER][MIXED] Quiet, but I've got to wait as long as.
[CUSTOMER][NEUTRAL] [PII], he's [PII].
[CUSTOMER][POSITIVE] I'm just on the phone with the insurance company, but he's ready.
[AGENT][NEUTRAL] Give me just.
[CUSTOMER][NEUTRAL] You [PII] fine.
[CUSTOMER][NEUTRAL] [PII].
[CUSTOMER][NEUTRAL] I don't mm.
[CUSTOMER][NEUTRAL] Um,
[CUSTOMER][NEUTRAL] B
[CUSTOMER][NEUTRAL] There's 3 of them. [PII] is. So you [PII].
[CUSTOMER][NEUTRAL] I grew up with someone, your aunt, yeah, not your daddy because your daddy wasn't even more.
[AGENT][NEGATIVE] I this is not uh.
[CUSTOMER][NEUTRAL] So I'm thinking this.
[CUSTOMER][NEUTRAL] Is this a um.
[CUSTOMER][NEUTRAL] Medical, say for the doctors or this is just a hospital?
[AGENT][NEUTRAL] Yeah, so it's just like it's like a limited benefit plan, um, hospital indemnity plan is what they call it.
[CUSTOMER][NEUTRAL] Policy.
[AGENT][NEUTRAL] And so, that's why, yeah, it just pays that set amount. It's not like a major medical.
[CUSTOMER][NEUTRAL] Oh, so you do allow him to go to a doctor's appointment.
[AGENT][NEUTRAL] Correct, yes, but it's just gonna pay that set amount. It doesn't have like a copay.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] I'll talk to you when you come out.
[CUSTOMER][NEUTRAL] OK, alright, so he's gonna be.
[AGENT][NEUTRAL] So, and I apologize, did you need the claims mailing address or the payer ID?
[CUSTOMER][NEUTRAL] Yep
[CUSTOMER][NEUTRAL] Both of them.
[AGENT][NEUTRAL] The payer ID is gonna be 64556.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] And for this policy, the claims would be submitted to IMA.
[CUSTOMER][NEUTRAL] Yeah
[CUSTOMER][NEUTRAL] Uh huh
[AGENT][NEUTRAL] And that's at [PII].
[CUSTOMER][NEUTRAL] 21704.
[AGENT][NEUTRAL] In [PII].
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] And the zip code is [PII].
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][POSITIVE] [PII]. OK, alright, well thank you so much. I appreciate your help and I hope you have a blessed day.
[AGENT][POSITIVE] You as well. Take care.
[CUSTOMER][NEUTRAL] OK, oh, sorry, sorry, what's the reference number to this call?
[AGENT][NEUTRAL] Bye bye, [PII]. Yes. [PII].
[AGENT][NEUTRAL] No problem. Call reference is my name with my last initial than today's date. So my name is [PII]. My last initial is [PII].
[CUSTOMER][POSITIVE] In today's date, OK, thank you so much.
[AGENT][NEUTRAL] Mhm.
[AGENT][POSITIVE] You're welcome. Have a good one, [PII].
[CUSTOMER][NEUTRAL] Alright bye bye.
[AGENT][NEUTRAL] Bye bye