AccountId: 011433970860
ContactId: f24a47a5-ca7a-41ed-9796-e7b684c517df
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 250550 ms
Total Talk Time (AGENT): 111710 ms
Total Talk Time (CUSTOMER): 78507 ms
Interruptions: 0
Overall Sentiment: AGENT=1.1, CUSTOMER=0.9
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/04/04/f24a47a5-ca7a-41ed-9796-e7b684c517df_20250404T16:27_UTC.wav
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[AGENT][NEUTRAL] Thank you for calling APL. This is [PII]. How can I help you?
[CUSTOMER][NEUTRAL] I'm sorry, what was your name?
[AGENT][NEUTRAL] [PII]
[CUSTOMER][POSITIVE] Perfect, um, I was calling to verify benefits and eligibility.
[AGENT][NEUTRAL] OK, yes, I can check uh eligibility and benefits for you. What was your name?
[CUSTOMER][NEUTRAL] [PII].
[AGENT][POSITIVE] Hey [PII], can I get a good call back number from you in case we're disconnected?
[CUSTOMER][NEUTRAL] Yes, [PII].
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] Thank you. And then do you have that policy number?
[CUSTOMER][NEUTRAL] Yes.
[CUSTOMER][NEUTRAL] So on the card it says policy number and then there's a medical ID you need the policy number?
[AGENT][NEUTRAL] Yes, please.
[CUSTOMER][NEUTRAL] OK, 026.
[CUSTOMER][NEUTRAL] 06454.
[AGENT][NEUTRAL] OK, and then uh what was the name and date of birth for the member, please?
[CUSTOMER][NEUTRAL] Um, name is, um, the first name is [PII], last name [PII]. Date of birth [PII].
[AGENT][NEUTRAL] Perfect, thank you for verifying that [PII]. Uh, so this policy is active. Effective date was [PII], and this is a limited indemnity medical plan, so it pays a set dollar amount uh per covered procedure or office visit. Um, there's no co-pays, no deductibles, and no authorization required.
[CUSTOMER][NEUTRAL] OK, um, does the patient have emergency room benefits?
[AGENT][NEUTRAL] Let me check that. Give me just a moment.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Oh yeah.
[AGENT][NEUTRAL] Did the patient have to have a surgery or any sort of uh diagnostic test?
[CUSTOMER][NEUTRAL] Um, I don't believe so. Let me check.
[CUSTOMER][NEUTRAL] Um,
[CUSTOMER][NEUTRAL] I'm sorry.
[AGENT][NEUTRAL] No, you're fine. This policy is very specific as to what it does cover.
[CUSTOMER][NEUTRAL] Right, so it looks like he had, he was here for knee pain and it looks like they did an X-ray.
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Um, other, other, but other than that, that was the only other like additional testing that he had.
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Other than just seeing the ER doctor.
[AGENT][NEUTRAL] OK, one moment.
[AGENT][NEUTRAL] So this policy, of course, I will let you know verification of coverage is not a guarantee of payment for claims. So there's nothing for specifically for emergency room visits. Uh, he does have an outpatient sickness benefit that would be covered in an emergency room facility, but that would be regarding a covered sickness. And then he does have a diagnostic testing benefit as well.
[AGENT][NEUTRAL] Um, but that explicitly states that's going to be for MRI, CT scan, or colonoscopy. So it does not look like he has any covered benefits for what he was being seen for.
[CUSTOMER][POSITIVE] Perfect. That's what I needed to know. Um, can I get a call, a call reference number?
[AGENT][POSITIVE] Got it. All right.
[AGENT][NEUTRAL] Sure.
[AGENT][NEUTRAL] Yes, that would just be my first name, last initial, and today's date. Uh, so my name is spelled [PII] Was there anything else I could help you with, [PII]?
[CUSTOMER][POSITIVE] No, that's perfect. Thank you so much.
[AGENT][POSITIVE] Alright, yeah, thanks for calling APL. I hope you have a great rest of your day.
[CUSTOMER][NEUTRAL] You too, bye.
[AGENT][POSITIVE] Thank you. Bye-bye.