AccountId: 011433970860
ContactId: 027a1167-0a4d-4f8b-bc03-7cc4520c75c9
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 588359 ms
Total Talk Time (AGENT): 204056 ms
Total Talk Time (CUSTOMER): 186831 ms
Interruptions: 1
Overall Sentiment: AGENT=0.3, CUSTOMER=1.4
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/05/21/027a1167-0a4d-4f8b-bc03-7cc4520c75c9_20250521T15:14_UTC.wav
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[AGENT][NEUTRAL] Thank you for calling APL. This is [PII]. How may I help you?
[CUSTOMER][NEUTRAL] Hi, [PII]. My name is [PII]. I'm calling from [PII] ENT. I need to verify eligibility and benefits for a member of ours, please.
[AGENT][NEUTRAL] OK, Ms. [PII], I can help you with both eligibility and benefits. Can I please get your callback number, ma'am, just in case the call is dropped.
[CUSTOMER][NEUTRAL] Yes, it's [PII].
[AGENT][NEUTRAL] Thank you. And then what is the patient's name, date of birth, and policy number?
[CUSTOMER][NEUTRAL] Sure. Uh, the first name of the patient is Blessing. Last name is [PII].
[CUSTOMER][NEUTRAL] And the policy number is 0611564 M as in Mary, L as in Larry 8.
[AGENT][NEUTRAL] OK, let me look up that policy real quick.
[AGENT][NEUTRAL] OK, and you said that policy number was 0611564ML8.
[CUSTOMER][POSITIVE] Yes, correct.
[AGENT][NEUTRAL] OK, that policy number is not pulling in for me. It looks like it's one digit short.
[AGENT][NEUTRAL] Of being
[CUSTOMER][NEUTRAL] Oh boy, OK, give me one second.
[AGENT][NEUTRAL] Yes, ma'am. Yes ma'am.
[CUSTOMER][NEUTRAL] Let me see if I have a copy of the card here.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] Or if you have the social I could pull it in with social also.
[CUSTOMER][NEUTRAL] OK, let me see which one I find first.
[AGENT][NEUTRAL] Yes, ma'am.
[CUSTOMER][NEUTRAL] Yeah, the copy of the card that I have is not a very good one. Let me see if we have a social.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] Yeah, I don't have a social. She didn't provide one.
[AGENT][NEUTRAL] OK, let's try to look with the member's name. Can you spell the first name for me?
[CUSTOMER][NEUTRAL] Hm.
[CUSTOMER][NEUTRAL] Sure, it's [PII].
[AGENT][NEUTRAL] OK, and spell the last name for me?
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] [PII], OK, let's look.
[AGENT][NEUTRAL] I'm gonna try to pull it in by this name.
[AGENT][NEUTRAL] And the last name is [PII], and the first name is Blessing.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] That's what
[CUSTOMER][POSITIVE] Correct, mhm.
[AGENT][NEUTRAL] OK
[AGENT][NEUTRAL] Let me reverse it and try it the other way with [PII] being the last name and [PII] being the first name.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] OK, I'm not able to pull anybody up with that name.
[CUSTOMER][NEUTRAL] Oh OK.
[CUSTOMER][NEUTRAL] That's so weird cause I see that there's a card scanned, but the card is so like.
[CUSTOMER][NEUTRAL] It's blurry. I can't make out the ID. Let me see.
[AGENT][NEUTRAL] Mhm.
[AGENT][NEUTRAL] Is is blessing the um policy holder?
[CUSTOMER][NEUTRAL] So, uh, no, let me see if.
[CUSTOMER][NEUTRAL] So the policy holder I that I could read on the card.
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Can we maybe look at the policyholder's name? Uh I'm assuming it's the mother. Um it's uh spelled S, first name, [PII]
[AGENT][NEUTRAL] Yes.
[AGENT][NEUTRAL] Shuffle.
[CUSTOMER][NEUTRAL] And then the last name is [PII], [PII]
[AGENT][POSITIVE] OK, let's try to do it this way.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] OK, OK, I've got.
[AGENT][NEUTRAL] All right, I do have [PII] pulled up.
[CUSTOMER][NEUTRAL] Mhm, mhm.
[AGENT][NEUTRAL] And
[AGENT][NEUTRAL] What is Blessing's date of birth?
[CUSTOMER][NEUTRAL] Her date of birth is [PII].
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] OK, I've got mama pulled up, but I do not have blessing on the policy.
[AGENT][NEUTRAL] Wait a minute, it's a different name. [PII]. It's [PII].
[CUSTOMER][NEUTRAL] No? OK.
[CUSTOMER][NEUTRAL] Yes.
[CUSTOMER][NEUTRAL] Aa
[AGENT][NEUTRAL] Yeah, that's what I'm showing AIA.
[CUSTOMER][NEUTRAL] Mm.
[AGENT][NEUTRAL] With the date of birth, [PII].
[AGENT][NEUTRAL] As a dependent.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] I don't know where this name came from then. Give me one second, let me fix this.
[AGENT][NEUTRAL] Yes ma'am.
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][POSITIVE] Wow.
[CUSTOMER][NEUTRAL] this.
[CUSTOMER][NEUTRAL] 15 yep, OK.
[CUSTOMER][NEUTRAL] Yeah, I just confirmed her um.
[CUSTOMER][NEUTRAL] Her um member ID for her primary insurance and it says the same thing. It's [PII]. I don't know where this other name came from, how weird. OK, um.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] Yes, ma'am.
[AGENT][NEUTRAL] OK, so.
[CUSTOMER][NEUTRAL] Can, uh, can you provide me the correct ID number for this patient?
[AGENT][NEUTRAL] Yes, ma'am.
[AGENT][NEUTRAL] Yes, ma'am. It's
[AGENT][NEUTRAL] 1611.
[AGENT][NEUTRAL] 564.
[CUSTOMER][NEUTRAL] So it's 161.
[CUSTOMER][NEUTRAL] And repeat the other numbers, I'm sorry?
[AGENT][NEUTRAL] Yeah.
[AGENT][NEUTRAL] Yes, 1611564.
[CUSTOMER][NEGATIVE] Oh, OK. Wow, it was completely wrong.
[AGENT][NEGATIVE] It's just is missing the one at the beginning.
[CUSTOMER][NEUTRAL] Mm, OK, and the uh group number?
[AGENT][NEUTRAL] But she does, uh-huh.
[AGENT][NEUTRAL] Yes, ma'am. Let me look and let me give you her effective date. It's [PII].
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][POSITIVE] Perfect.
[AGENT][NEUTRAL] And the policy is active and current. The group number is 22392.
[CUSTOMER][POSITIVE] Perfect.
[AGENT][NEUTRAL] And this is just to verify her benefits. It's not a guarantee of payment. This is a supplemental insurance policy that's billed secondary to the primary.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][POSITIVE] It helps with deductible, co-pay and co-insurance.
[AGENT][NEUTRAL] She has an inpatient benefit amount per calendar year of $2500 and then she has an outpatient calendar year benefit amount of $1500 to go towards deductible, co-pay or co-insurance.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] And has she used any of that amount so far?
[AGENT][NEUTRAL] Let me check for you real quick.
[AGENT][NEGATIVE] Nothing has been used for the year of [PII].
[CUSTOMER][NEUTRAL] OK, 0.
[CUSTOMER][POSITIVE] Perfect.
[AGENT][NEUTRAL] We did some digging, but we found her.
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][POSITIVE] Oh my I know thank you so much for your help.
[AGENT][POSITIVE] Yes. You're very welcome. Yes, Ms. [PII].
[CUSTOMER][POSITIVE] Alright perfect thank you have a good day.
[AGENT][POSITIVE] You're welcome. You have a good day too. Is that everything I can help you with before we go?
[CUSTOMER][POSITIVE] Yes, ma'am, that'll be it. Thank you.
[AGENT][NEUTRAL] OK.
[AGENT][POSITIVE] All right, you take care and have a good week. Bye-bye.
[CUSTOMER][POSITIVE] Alrighty bye bye.
[CUSTOMER][NEUTRAL] You too. Bye-bye.