AccountId: 011433970860
ContactId: 049e9fd6-8317-41b7-ba8a-0e63ef00e00e
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 615580 ms
Total Talk Time (AGENT): 324189 ms
Total Talk Time (CUSTOMER): 193818 ms
Interruptions: 2
Overall Sentiment: AGENT=0.7, CUSTOMER=-0.1
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/03/25/049e9fd6-8317-41b7-ba8a-0e63ef00e00e_20250325T13:27_UTC.wav
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[AGENT][NEUTRAL] Morning. Thank you for calling APL. This is [PII]. How may I assist you?
[CUSTOMER][NEUTRAL] Uh, yes, calling for benefit information.
[AGENT][POSITIVE] Sure, I can assist you with benefits. May I have your name?
[CUSTOMER][NEUTRAL] [PII]
[AGENT][POSITIVE] Thank you. And may I have a callback number just in case we get disconnected?
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] Thank you. Excuse me. Thank you. And may I have the patient's policy number, Miss [PII]?
[CUSTOMER][NEUTRAL] Yes, it is 01261895 M as in Michael L 8.
[AGENT][POSITIVE] OK, thank you.
[AGENT][NEUTRAL] May I have the name and date of birth of the patient?
[CUSTOMER][NEUTRAL] Yes, [PII], date of birth is [PII].
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] And what type of service is being run there for benefits?
[CUSTOMER][NEUTRAL] Uh, a specialist office visit with X-rays done in the office.
[AGENT][NEUTRAL] Let me check the benefits before I give you any benefit information, I need to let you know that this is not a guarantee of payment, just a verification of coverage, and that's just a disclaimer.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] And this is one of our secondary supplemental plans to the major medical. We have an effective date of [PII]. It is active at the moment.
[AGENT][NEUTRAL] And let's see.
[AGENT][NEGATIVE] Oh, this one doesn't have any benefits for office. It's all outpatient facility.
[CUSTOMER][NEGATIVE] Um, so if they have like X-rays in the office, that's not gonna be covered.
[AGENT][NEGATIVE] Nothing done in the office, not the office visit or not the office procedures. This one doesn't have any office benefit.
[CUSTOMER][NEUTRAL] OK, because when I called a month or so ago I was told that it covers everything except for.
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] $20 of the $70 copay that it covers $50 of the co-pay. That's what I was told, and then it covers everything else.
[CUSTOMER][NEUTRAL] Up to $1000.
[CUSTOMER][NEGATIVE] So now you're telling me it doesn't cover anything with yeah.
[AGENT][NEUTRAL] On this one.
[AGENT][NEUTRAL] No, I don't see anything. Let me pull the benefits but.
[AGENT][NEUTRAL] See.
[AGENT][NEUTRAL] OK, I see what's going on. She has two policies that are active. Why?
[AGENT][NEUTRAL] Bear with me just a second. Let me go to customer service and see what's going on with this policy. Do you mind holding for me, Miss [PII]?
[CUSTOMER][NEUTRAL] Uh
[CUSTOMER][NEUTRAL] OK, sure.
[CUSTOMER][NEGATIVE] No, not at all.
[AGENT][POSITIVE] Thank you.
[CUSTOMER][NEGATIVE] You are on hold.
[CUSTOMER][NEUTRAL] Referring
[CUSTOMER][NEUTRAL] Thank you for calling APL. This is [PII]. How can I help you?
[AGENT][NEUTRAL] Hi [PII], how are you? This is [PII].
[CUSTOMER][POSITIVE] Hey, I'm good. How are you?
[AGENT][POSITIVE] I'm getting better.
[AGENT][NEUTRAL] I'm under the weather, but I'm here.
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] Me too.
[AGENT][NEUTRAL] Yeah
[AGENT][NEUTRAL] Yeah, it's this pollen is killing me, um, but, um, I have, um, I have a situation with the policy. Um, there are two active policy for this member, and I just need to know which one is the correct one because they're both active.
[CUSTOMER][NEUTRAL] Oh.
[AGENT][NEUTRAL] Um,
[CUSTOMER][NEUTRAL] Oh, OK.
[AGENT][NEUTRAL] Yeah, so let me give you the most recent one is 02589447.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Uh, with the same.
[AGENT][NEUTRAL] This one doesn't have a.
[AGENT][NEUTRAL] Bain, uh-huh.
[AGENT][NEUTRAL] Yeah, and this one doesn't have a certificate, but the other one does, um.
[AGENT][NEUTRAL] I'm not sure which one is the right one.
[CUSTOMER][NEUTRAL] OK, now the correct one is the most recent, uh, it, let me see, let me look at one thing.
[CUSTOMER][NEUTRAL] Um, 11, OK, I will go ahead and lapse, the 1261895. It had a lapse date of [PII], but it looks like they did not pay December, so it's still active because of that.
[AGENT][NEUTRAL] Mm.
[AGENT][NEUTRAL] Uh
[AGENT][NEUTRAL] Oh, got you. OK, yeah, because she called like the provider called me to go and she was told something different and now I'm giving her different information and she's like, but why the information is different? I'm like, oh boy, OK, but she gave me the, the old one. That's why I was looking into that one. I thought that it was active.
[AGENT][NEUTRAL] OK, so the new one is the one that needs to be uh given out. The, the group number is different as well. The 80117 is the group, the correct group number.
[CUSTOMER][NEUTRAL] Right. Yeah.
[CUSTOMER][NEUTRAL] Uh, yes, yes, a lot of these groups are going to AsMed and they will have that 800 number, you know, it started with 800, but, um, you know, they're the same group, but they have a different number because they're AME, which is some kind of special something with Florida, so that's why that new group number.
[AGENT][NEUTRAL] But
[AGENT][NEUTRAL] Oh OK.
[AGENT][NEUTRAL] Um,
[CUSTOMER][NEUTRAL] Yeah, but that other one should be termed. I do need to check with billing about that though to see.
[AGENT][NEUTRAL] Mm, OK.
[CUSTOMER][NEUTRAL] If we've received the payment or anything like that.
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Because I would think they would pay it up to date, especially since they've already paid on the other one.
[AGENT][NEUTRAL] Yeah.
[CUSTOMER][NEGATIVE] Weird.
[AGENT][NEUTRAL] Hm.
[AGENT][NEUTRAL] OK, well, let me go ahead. Yeah, I don't know if, if you, um, if you can lapse it just in case she calls again and so she don't get so confused about the benefits, if you cannot, um, put a note that's stating that uh do not quote from this one, to quote from the other one, I guess. I don't know.
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] Right.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] Yes, so you know makes a confused. All right, so I'm gonna go ahead and just give her the whole information because she don't have no information about the new one, not the group number, not the policy number, nothing. The only thing she knows it does cover off treatment and then the amount that she was given was the old amount. So I'm like, oh, this is so messed up, but it's OK. I got it. I got it. All right, well you have a good day. Thank you, Ms. [PII].
[CUSTOMER][POSITIVE] OK, I sure will. Yes.
[CUSTOMER][NEUTRAL] Oh.
[CUSTOMER][NEUTRAL] All right.
[CUSTOMER][POSITIVE] Oh, I'm so sorry. OK. You too. You're welcome.
[AGENT][POSITIVE] OK. Thank you. Bye-bye.
[CUSTOMER][NEUTRAL] That.
[AGENT][POSITIVE] Thank you for holding and being patient for me Miss [PII].
[CUSTOMER][POSITIVE] You're welcome.
[AGENT][NEUTRAL] OK, so, uh, we do have a totally new policies, a new number, new group number, everything is new. So let me give you the information because even the amount is different.
[CUSTOMER][NEUTRAL] Oh
[AGENT][POSITIVE] And I do apologize for the inconvenience you had to active policies. We had to, you know, make a decision which one is the right one, but it's the new one.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK, so what's the new policy number?
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] Alright, so the new policy number is 02.
[AGENT][NEUTRAL] 58
[AGENT][NEUTRAL] 9447.
[AGENT][NEUTRAL] The effective date on this one is [PII].
[AGENT][NEUTRAL] It is active at the moment.
[CUSTOMER][NEUTRAL] OK, let me just go with that number. It's a short it's a short number like that 202589-447.
[AGENT][NEUTRAL] Yes, um, you don't have to put the email if you would like to put the email, you can, but it's not necessary. ML is just a product type.
[AGENT][NEUTRAL] And the aid is just outpatient.
[CUSTOMER][NEUTRAL] OK, what about as a group number?
[AGENT][NEUTRAL] Yes, let me give you the new group number because it is different. Um, the new group number is 80117.
[CUSTOMER][NEUTRAL] OK
[AGENT][NEUTRAL] OK, for the benefits, again, the benefits are different. So for this one, we have um an outpatient maximum uh daily benefit is 4700.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] And this includes office treatments. So it includes procedures done in the office. It does not include the co-payment for the visit, so it does not cover the co-pay. It's just for office treatments only.
[CUSTOMER][NEUTRAL] OK, so like X-rays and if they have like uh an injection or something that's covered.
[AGENT][NEUTRAL] Injections, yeah, mhm, sonograms, ultrasounds, stuff like that, yes. Mhm.
[CUSTOMER][NEUTRAL] OK, um.
[CUSTOMER][NEUTRAL] All right, um, that's pretty much what I needed, um, can I get a reference number?
[AGENT][NEUTRAL] Mm
[AGENT][NEUTRAL] Yeah.
[AGENT][NEUTRAL] Uh, we don't have reference numbers. You can use my name in today's date if you will. Do you need the spelling of my name or any other information?
[CUSTOMER][NEUTRAL] Yeah, the spelling of your name?
[AGENT][NEUTRAL] Sure, that's [PII], last initial [PII].
[CUSTOMER][POSITIVE] OK all right great thank you so much for your help.
[AGENT][POSITIVE] You're welcome and thank you for calling APL. Have a good day.
[CUSTOMER][NEUTRAL] You too bye.
[AGENT][POSITIVE] Thank you.