AccountId: 011433970860
ContactId: 07bdadf2-47cf-49f0-8653-087f9757dee6
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 242690 ms
Total Talk Time (AGENT): 105379 ms
Total Talk Time (CUSTOMER): 68499 ms
Interruptions: 1
Overall Sentiment: AGENT=0.5, CUSTOMER=0.7
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/01/31/07bdadf2-47cf-49f0-8653-087f9757dee6_20250131T13:05_UTC.wav
--------------------------------------------
[AGENT][POSITIVE] Good morning. Thank you for calling APL. This is [PII]. How can I help you?
[CUSTOMER][NEUTRAL] Hi [PII], good morning. My name is [PII] and I'm calling from Adjustive Medicine Associates. I have a patient that is going to have a procedure in an ambulatory surgery center, and I need his benefits.
[AGENT][NEUTRAL] OK, you're needing to get eligibility and benefits for a member, is that correct?
[CUSTOMER][NEUTRAL] Yes it is.
[AGENT][POSITIVE] Yes, ma'am. I can help you with that, and I'm so sorry. Could you please give me your name again?
[CUSTOMER][NEUTRAL] It's [PII]
[AGENT][NEUTRAL] Thank you. And [PII], what is your callback number, please?
[CUSTOMER][NEUTRAL] [PII]
[AGENT][NEUTRAL] Thank you. And the member's policy number?
[CUSTOMER][NEUTRAL] It's 17237.
[AGENT][NEUTRAL] OK, that would be a group number.
[AGENT][NEUTRAL] There's another number on the ID card.
[CUSTOMER][NEUTRAL] Oh, that's the only number I have.
[CUSTOMER][NEUTRAL] I don't have the card. That's the only number I have.
[AGENT][NEUTRAL] One moment.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] And what is the name of the patient so I can try and locate the policy?
[CUSTOMER][NEUTRAL] It's [PII].
[AGENT][NEUTRAL] OK, [PII], any information that I do provide will be a verification of benefits and not a guarantee of payment. What is her date of birth?
[CUSTOMER][NEUTRAL] OK, his, uh, her date of birth is, um, [PII].
[AGENT][NEUTRAL] Thank you. So I did look at a policy for her. She is a subscriber on the supplemental policy and it is active with an effective date of [PII].
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] And on this policy her outpatient benefit maximum per calendar year for covered outpatient services, her cover person is $1000 and there is no outpatient deductible per covered person per calendar year.
[CUSTOMER][NEUTRAL] OK, and um, how, uh, sorry, go ahead.
[AGENT][NEUTRAL] And then
[AGENT][NEUTRAL] I was gonna say and because this is a supplement to her primary insurance, we must also have a copy of her primary insurance's explanation of benefits along with the claim for review and then once we have processed our claim, you all may check status by going to our portal at [PII].
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Alright, and, um, uh, can you tell me if uh the best uh benefits is still available the whole thing?
[AGENT][NEGATIVE] As of now, she has not used any benefits for this calendar year.
[CUSTOMER][POSITIVE] OK, perfect.
[CUSTOMER][NEUTRAL] Alright, um, can I get a reference number?
[AGENT][NEUTRAL] Is there anything else?
[AGENT][NEUTRAL] Yes, ma'am. You would use my name that I, you would use my name that I gave you along with today's date.
[CUSTOMER][POSITIVE] That's it, thank you.
[CUSTOMER][NEUTRAL] OK, and what's the nature of your last name?
[AGENT][NEUTRAL] S
[CUSTOMER][POSITIVE] Perfect, thank you very much and have a nice day.
[AGENT][POSITIVE] I hope you have a great day too, and thank you again, [PII], for calling APL.
[CUSTOMER][NEUTRAL] OK
[CUSTOMER][NEUTRAL] Mhm bye bye.
[AGENT][NEUTRAL] Uh huh bye bye.