AccountId: 011433970860
ContactId: 014f59b0-69b9-479a-a71a-942153e433bf
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 623919 ms
Total Talk Time (AGENT): 255189 ms
Total Talk Time (CUSTOMER): 366094 ms
Interruptions: 19
Overall Sentiment: AGENT=0.4, CUSTOMER=0.4
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/06/03/014f59b0-69b9-479a-a71a-942153e433bf_20250603T22:15_UTC.wav
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[CUSTOMER][POSITIVE] He tries to eat healthy like he never had a problem before.
[AGENT][NEUTRAL] Thank you for calling AP sales. This is [PII]. How may I help you?
[CUSTOMER][NEUTRAL] You don't
[CUSTOMER][NEUTRAL] Hi, um, this is what a what's the.
[AGENT][NEUTRAL] APL American Public Life. My name is [PII].
[CUSTOMER][NEUTRAL] Oh, OK, OK, hi [PII], I'm calling because I wanted to just.
[CUSTOMER][NEUTRAL] 00 sorry, it scared of there was thunder. We don't get thunder here often, um.
[AGENT][NEUTRAL] Oh,
[CUSTOMER][NEUTRAL] No, that was pretty loud, um, so I'm calling because I have a patient that's scheduled for tomorrow, and I just needed to verify how many visits they have left.
[AGENT][NEUTRAL] OK, I can help you with um both eligibility and benefits. Can I please get your name and your callback number?
[CUSTOMER][NEUTRAL] T
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] My name is [PII]. Callback number is [PII].
[CUSTOMER][NEUTRAL] I, I don't know if this is accurate or not.
[AGENT][NEUTRAL] OK, and then what is the member's name, date of birth, and policy number?
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] So patient's name is [PII] OK and then the ID number that we have on file is [PII] in [PII].
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] OK, and you're needing benefit information for [PII]?
[CUSTOMER][NEUTRAL] I
[CUSTOMER][NEUTRAL] OK
[CUSTOMER][NEUTRAL] Yeah, so we need to know because he has an appointment for a consult tomorrow, so we just wanna make sure that we're network and if it's OK for him to be seen and also the co-pay.
[AGENT][NEUTRAL] OK, alright, so what I'm gonna need to do, um, he's with uh 90 Degree Benefits. I can tell by the policy number you gave me, and I'm gonna transfer you on over to the 90 Degree Benefits and let me give you that phone number.
[CUSTOMER][NEUTRAL] Yeah
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] OK, is that.
[CUSTOMER][NEUTRAL] Is it [PII]? That's the one I just called and they told me to call you.
[AGENT][NEUTRAL] Yes.
[AGENT][NEUTRAL] And then you would choose
[AGENT][NEUTRAL] Did you choose option one?
[AGENT][NEUTRAL] Oh, OK. All right, well, let's get his social then.
[CUSTOMER][NEUTRAL] Uh huh
[CUSTOMER][NEUTRAL] Mm let me see.
[CUSTOMER][NEUTRAL] Um, I don't even know if we have that, um.
[CUSTOMER][NEUTRAL] Hold on.
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Um,
[AGENT][NEUTRAL] Or if you see an APL policy number, might start with a 01 or 02.
[CUSTOMER][NEUTRAL] APR policy.
[CUSTOMER][NEUTRAL] Mm.
[CUSTOMER][NEUTRAL] Hold on.
[CUSTOMER][POSITIVE] I agree.
[CUSTOMER][NEUTRAL] Mm, I don't see that. I just see the ID number.
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] And uh let me see.
[AGENT][NEUTRAL] Will you spell his first name for me?
[CUSTOMER][NEUTRAL] It's in
[CUSTOMER][NEUTRAL] [PII]
[AGENT][NEUTRAL] OK, and then spell the last name for me.
[CUSTOMER][NEUTRAL] It is [PII]
[AGENT][NEUTRAL] OK, let me see if I can, while you're trying to find that number I'm gonna look and see if I can find him by his name.
[CUSTOMER][POSITIVE] No worries.
[CUSTOMER][NEUTRAL] OK
[CUSTOMER][NEUTRAL] Yeah, sorry, I've I've been transferred so many times and I've been giving so many different numbers, yeah.
[AGENT][NEUTRAL] I understand.
[CUSTOMER][NEUTRAL] And we just wanna, we don't wanna cancel this appointment for tomorrow.
[AGENT][NEUTRAL] Right, I understand.
[CUSTOMER][NEUTRAL] Um, let me see.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] I am pulling him up. His date of birth is [PII]. Is that correct?
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Yeah, we only have the last four of the socials and it's [PII].
[AGENT][POSITIVE] OK, alright, thank you.
[CUSTOMER][NEUTRAL] That's all I have.
[CUSTOMER][POSITIVE] Perfect, I'm glad you
[AGENT][NEUTRAL] Yeah, I don't believe that social you have is gonna be accurate. I have a different social for him, um.
[CUSTOMER][NEUTRAL] Oh, OK, maybe they just put, yeah, because it's just says XXX. Yeah, they probably didn't have it and they just.
[AGENT][NEUTRAL] Yeah, it looks
[AGENT][NEUTRAL] They just put it in there? Yeah, OK.
[AGENT][NEUTRAL] Oh yes, ma'am. OK, so I do show that he does have an active policy. The effective date of his policy is [PII].
[CUSTOMER][NEUTRAL] Um, so they can
[CUSTOMER][NEUTRAL] No it can happen.
[CUSTOMER][NEUTRAL] you want to invite.
[CUSTOMER][NEUTRAL] that was
[CUSTOMER][NEUTRAL] Already sent for.
[CUSTOMER][NEUTRAL] Um, effective hold on.
[AGENT][NEUTRAL] And it is current.
[CUSTOMER][NEUTRAL] OK, and um so this is a limited policy or or is it, is it limited medical plan?
[AGENT][NEUTRAL] Yes, it's a limited hospital indemnity plan.
[CUSTOMER][NEUTRAL] OK, so how many visits does he have left or can he be seen tomorrow? Um, so it's for a consultation, outpatient hospital visit, so it's a consult a specialist.
[AGENT][NEUTRAL] What kind of a facility are you?
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] All right.
[AGENT][NEUTRAL] OK, so it's a physician's office. Is that correct?
[CUSTOMER][NEUTRAL] Yes mhm.
[AGENT][NEUTRAL] OK. So he does have, um,
[AGENT][NEUTRAL] Let's see.
[AGENT][NEUTRAL] I'm looking to see what kind of benefits he has for a physician's office.
[CUSTOMER][NEUTRAL] Yeah
[AGENT][NEUTRAL] I need to pull up his policy because
[CUSTOMER][NEUTRAL] So based on what I.
[AGENT][NEUTRAL] It says that he has accident or sickness surgical benefit in a physician's office, but I wanna make sure he has physician office visits.
[CUSTOMER][NEUTRAL] Yeah
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] Without the surgery.
[CUSTOMER][NEUTRAL] So would it make a difference if it's outpatient hospital visit, like a specialist visit, or it it all falls within the same?
[AGENT][NEUTRAL] It still falls in with the outpatient benefits, um, this policy is um.
[CUSTOMER][NEUTRAL] Oh, OK, OK.
[AGENT][NEUTRAL] Like he has inpatient visits and then outpatient visits, so we wanna make sure that we.
[CUSTOMER][NEUTRAL] Mm.
[AGENT][NEUTRAL] Um,
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] But let me make sure I'm gonna pull up his policy and read the policy certificate so we can make sure that he can be seen tomorrow or not.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Um, what is that I'll give you just, so that's what what I'm gonna do is I'm gonna call and have them send me the record.
[AGENT][NEUTRAL] It's gonna be just a moment for my computer to pull it in for us.
[CUSTOMER][POSITIVE] OK, thank you.
[CUSTOMER][NEUTRAL] And see if that makes a difference.
[AGENT][POSITIVE] You're welcome.
[CUSTOMER][NEUTRAL] Never know what if they see the notes and they're like, OK, you know what, let's just, let's see them here in clinic or let's do a procedure, whatever the case.
[CUSTOMER][POSITIVE] Um, it's good for them to see those notes so they can.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Problem, let me call them now and then let me request the records once I get them all.
[CUSTOMER][NEUTRAL] And then I'll let you know what the outcome is, OK, but that request is.
[CUSTOMER][NEGATIVE] Provider is still pending authorization but it was already sent.
[AGENT][NEUTRAL] Give me just a moment. It, it takes a little bit for it to load and then I'll have to scroll through and find its benefits.
[CUSTOMER][POSITIVE] Thank you
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] He does not have outpatient benefits in a physician's office. He only has hospital admission.
[AGENT][NEUTRAL] He has an accident and surgery benefit.
[AGENT][NEUTRAL] Diagnostic testing and critical illness. So there's nothing on here that states that he can go to a physician's office for treatment.
[CUSTOMER][NEUTRAL] Oh, OK.
[CUSTOMER][NEUTRAL] So he only has inpatient visit.
[AGENT][NEUTRAL] I'm gonna look and see
[AGENT][NEUTRAL] Yeah, that's what it's looking like, but I'm checking to make sure there's no riders that I'm missing, so I'm gonna make double sure.
[CUSTOMER][NEUTRAL] Yeah
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] No, ma'am. He doesn't have any riders for outpatient, only for surgery.
[CUSTOMER][NEUTRAL] Oh, OK.
[CUSTOMER][NEUTRAL] Does that just mean that he's already been seen, like he's already hit his cap?
[AGENT][NEUTRAL] No, his, his policy doesn't cover it.
[CUSTOMER][NEUTRAL] So he would have to pay cash, huh, if you would like.
[AGENT][NEUTRAL] It's non-covered.
[AGENT][NEUTRAL] Um,
[AGENT][NEUTRAL] I can't give the patient responsibility because the provider usually determines that. But yeah, under his policy, he does not have outpatient physician office visits for treatment of sickness or anything like that. It's just for surgery.
[CUSTOMER][NEUTRAL] Oh OK, OK. Oh, so then he wouldn't, OK, so he doesn't have a patient visit, only inpatient, OK, and your name?
[AGENT][POSITIVE] Correct.
[AGENT][NEUTRAL] My name is [PII]
[CUSTOMER][NEUTRAL] Um.
[CUSTOMER][NEUTRAL] towards the end of April. OK, um, sounds good. Um, is there a reference number you can give me? It was emailed and also um. OK, thank you. [PII].
[AGENT][NEUTRAL] Yes, ma'am. You can use my name and today's date.
[AGENT][POSITIVE] You're very welcome, Ms. [PII]. Is that everything I can help you with before we go?
[CUSTOMER][POSITIVE] OK, yes, yes, you've been great, thank you. OK, you too. Alright, bye.
[AGENT][NEUTRAL] Uh.
[AGENT][POSITIVE] You're welcome. You have a wonderful night and thank you for calling APL.
[AGENT][NEUTRAL] Bye-bye.