AccountId: 011433970860
ContactId: 0185e024-4aa9-40c8-b5cf-0e62f0e1b32c
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 262980 ms
Total Talk Time (AGENT): 114346 ms
Total Talk Time (CUSTOMER): 90427 ms
Interruptions: 0
Overall Sentiment: AGENT=0.9, CUSTOMER=0.3
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/02/14/0185e024-4aa9-40c8-b5cf-0e62f0e1b32c_20250214T16:34_UTC.wav
--------------------------------------------
[AGENT][POSITIVE] Good morning. Thank you for calling APL. My name is [PII]. How may I help you?
[CUSTOMER][NEUTRAL] Hi, good morning. I'm sorry, what is your name?
[AGENT][NEUTRAL] My name is [PII].
[CUSTOMER][NEUTRAL] Hi [PII], my name is [PII]. I'm calling to get eligibility and benefits for uh patient.
[AGENT][NEUTRAL] OK, I can help you with both the eligibility and benefits, and [PII], may I have a good contact number in case we're disconnected?
[CUSTOMER][NEUTRAL] Yeah
[CUSTOMER][NEUTRAL] [PII].
[CUSTOMER][NEUTRAL] [PII].
[CUSTOMER][NEUTRAL] [PII] [PII].
[AGENT][NEUTRAL] Thank you for that. And may I have the member's policy number?
[CUSTOMER][NEUTRAL] I see your ID as 60801.
[AGENT][NEUTRAL] So that's our payer ID. Um, do you see anywhere that says policy?
[AGENT][NEUTRAL] Certificate number?
[CUSTOMER][NEUTRAL] Um
[CUSTOMER][NEUTRAL] I don't. Can I provide you with the name and date of birth?
[AGENT][NEUTRAL] Um, yes, or their social would be easier if you have it.
[CUSTOMER][NEUTRAL] Let me see if I have their social, hold on.
[AGENT][NEUTRAL] But if you have the payer ID, then that's our card. I just, do you see anywhere that says in hospitals or outpatient?
[CUSTOMER][NEUTRAL] Mm, no, because we don't have the card in front of us. She just gave me this number to call and find out if they cover her deductible because she's coming in to do a procedure here in the office. Let me see if I have her social. Hold on.
[AGENT][NEUTRAL] Oh, OK, OK.
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Um, no, she did not provide us with her social.
[CUSTOMER][NEUTRAL] The the the one
[CUSTOMER][NEUTRAL] Right
[AGENT][POSITIVE] OK, well, I can look at that with the first and last name. That's no problem at all.
[CUSTOMER][POSITIVE] OK, thank you.
[AGENT][POSITIVE] You're welcome.
[AGENT][NEUTRAL] Whenever you're ready.
[CUSTOMER][NEUTRAL] OK. Patient's name is [PII]
[AGENT][NEUTRAL] Thank you, hold on one moment.
[CUSTOMER][NEUTRAL] Date of birth is [PII].
[CUSTOMER][NEUTRAL] No
[AGENT][NEUTRAL] Hold on one moment, just waiting for the policies to populate.
[AGENT][NEUTRAL] OK, and it just came up.
[AGENT][NEUTRAL] Just waiting for you. Hold on one moment.
[AGENT][NEUTRAL] Alright, and thank you for verifying her date of birth and all the information provided is a verification of benefits, not a guarantee of payment. So the policy number is 241.
[CUSTOMER][NEUTRAL] 241.
[AGENT][NEUTRAL] 97
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] 63
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] And the policy has been active since [PII]?
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] And what type of benefits would you like to go over today?
[CUSTOMER][NEUTRAL] Um, so she's coming to our office, um, to do ultrasounds, and she's gonna have, she has a deductible with the primary, which is United. Um, I'm calling to verify to see if she is covered with her secondary for the deductible.
[AGENT][NEUTRAL] OK, so our policies do um pay towards the copay, deductible and co-insurance of covered charges after primary. We are second to United Healthcare. Um, so the benefit would be the outpatient benefit and the policy would pay up to $2000 per calendar year.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] Um, that does include diagnostic testing in an outpatient hospital facility or an MRI facility. The policy also has the office treatment rider, so if it is done in office, um, it would, it could be covered up to that $2000 as long as it's not cosmetic.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Oh OK.
[CUSTOMER][NEUTRAL] OK, and can I have a reference number for this um call?
[AGENT][NEUTRAL] Sure, so there's no call reference number. You can use my name in today's date and the first initial to my last name is [PII].
[CUSTOMER][POSITIVE] Thank you, [PII], you have a great day.
[AGENT][POSITIVE] Thank you, [PII]. You also, and thanks for calling APL.
[CUSTOMER][NEUTRAL] Bye.
[AGENT][NEUTRAL] Bye bye