AccountId: 011433970860
ContactId: f22bae93-de19-489d-b0b4-ddb0872d4ae1
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 266790 ms
Total Talk Time (AGENT): 119569 ms
Total Talk Time (CUSTOMER): 69759 ms
Interruptions: 0
Overall Sentiment: AGENT=1.4, CUSTOMER=1.3
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/05/27/f22bae93-de19-489d-b0b4-ddb0872d4ae1_20250527T13:19_UTC.wav
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[AGENT][POSITIVE] Good morning. Thank you for calling APL. My name is [PII]. How may I help you?
[CUSTOMER][NEUTRAL] Hi, good morning. My name is [PII]. I'm calling on behalf of the provider's office. I have a patient coming in. I just wanted to check on um eligibility and benefits.
[AGENT][POSITIVE] All right. Well, I'll be more than happy to help you with both the eligibility and the benefits. And [PII], may I have a good contact number in case we're disconnected and the member's policy number?
[CUSTOMER][NEUTRAL] Yes, my number is [PII].
[CUSTOMER][NEUTRAL] Um, the policy number I have is 02595525.
[AGENT][NEUTRAL] Thank you, hold on one moment.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] And can you verify the member's first and last name and date of birth?
[CUSTOMER][NEUTRAL] Yes, it's [PII]. Date of birth is [PII].
[AGENT][NEUTRAL] Thank you for that and all the information provided is a verification of benefits, not a guarantee of payment. So I am showing the policy is active. It's been effective since [PII]. And what type of benefits did you want to go over today?
[CUSTOMER][NEUTRAL] He's having an office visit with a cardiologist, um, and he wants might have an echocardiogram done in the office as well.
[CUSTOMER][NEUTRAL] Is this his primary insurance?
[AGENT][NEUTRAL] No, this is a secondary in well, hold on one second.
[AGENT][NEUTRAL] Let me make sure.
[AGENT][NEUTRAL] This is a hospital indemnity policy. Um, so we could be the only insurance he has. He may have other insurance policies. Um, it's not a major medical insurance policy.
[CUSTOMER][NEUTRAL] Oh, but you do pay for medical claims?
[AGENT][NEUTRAL] Yes, it's a medical policy. I'm just saying it's not like a Blue Cross Blue Shield Cigna, it's not a major medical.
[CUSTOMER][NEUTRAL] Oh, OK, OK. Um, is he covered if he has an office visit and an echocardiogram with the cardiologist?
[AGENT][NEUTRAL] So, I'm looking at the um benefits for you now. Hold on one moment.
[CUSTOMER][POSITIVE] OK, thank you.
[AGENT][POSITIVE] You're welcome.
[AGENT][NEUTRAL] I'm just waiting for the policy documents to populate. Do you mind if I place you on just a brief hold?
[CUSTOMER][POSITIVE] Sure, that's fine, no problem.
[AGENT][NEUTRAL] OK, hold on one moment. Thank you.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEGATIVE] You are on hold.
[AGENT][NEUTRAL] Sure, cardiologist and so.
[AGENT][NEUTRAL] Uh.
[AGENT][NEUTRAL] OK. Hello, [PII].
[CUSTOMER][NEUTRAL] Yes.
[AGENT][NEUTRAL] All right, thank you so much for holding. I apologize for that wait. So for the physician's office, the policy would pay up to $50 per day with a max of 4 days per calendar year.
[AGENT][NEUTRAL] And then for the echocardiogram, if it's trans, I'm gonna try to say this, transesophageal.
[AGENT][NEUTRAL] Um, then it's considered an advanced study which the policy would pay $25 per day with a max of 1 day per calendar year.
[CUSTOMER][NEUTRAL] OK, um, is alright is authorization supposed to be obtained or?
[AGENT][NEUTRAL] No authorization is required.
[CUSTOMER][NEUTRAL] OK, thank you. Can I just have a reference number please?
[AGENT][NEUTRAL] Sure, so there's no call reference number, but you can use my name in today's date, and again, that's [PII], first initial to my last name is [PII].
[CUSTOMER][POSITIVE] OK, thank you [PII].
[AGENT][POSITIVE] You're very welcome, [PII]. Thanks for calling APL. I hope you have a good day.
[CUSTOMER][POSITIVE] You too thank you bye bye.
[AGENT][POSITIVE] You're welcome bye bye.