AccountId: 011433970860
ContactId: 07e11c15-b331-4381-b84d-5b5569b6af7f
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 383959 ms
Total Talk Time (AGENT): 99561 ms
Total Talk Time (CUSTOMER): 169182 ms
Interruptions: 0
Overall Sentiment: AGENT=0.4, CUSTOMER=0.4
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/03/25/07e11c15-b331-4381-b84d-5b5569b6af7f_20250325T19:10_UTC.wav
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[AGENT][NEUTRAL] Thank you for calling APL. This is [PII]. How can I help you?
[CUSTOMER][NEUTRAL] Hi, my name is [PII], and my last initial name is [PII] I'm a patient care specialist. I'm calling from provider's office, and I want to verify the drug coverage benefits for a patient.
[AGENT][NEUTRAL] OK, and I can verify benefits for you. Do you have the uh a good call back number?
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Yes, uh, it's [PII].
[AGENT][NEUTRAL] And what's the policy number of the patient?
[CUSTOMER][NEUTRAL] Uh, OK. uh, sorry?
[AGENT][NEUTRAL] The policy number for the patient?
[CUSTOMER][NEUTRAL] Policy number, uh, what is it about? Like, um,
[AGENT][NEUTRAL] You you're wanting to look at benefits for a patient?
[CUSTOMER][NEUTRAL] You
[CUSTOMER][NEUTRAL] Uh, yeah, but, uh, you mean the member ID or?
[AGENT][NEUTRAL] Yes, the member ID.
[CUSTOMER][NEUTRAL] OK, yeah, the member ID is 02595584.
[AGENT][NEUTRAL] And patient name and date of birth?
[CUSTOMER][NEUTRAL] Uh the first name is [PII], and the last name is [PII]. Uh date of birth is [PII].
[AGENT][NEUTRAL] OK, this is not a guarantee of payments, it's just a basic outline of the policy. I show her effective [PII] or [PII].
[CUSTOMER][NEUTRAL] Yeah.
[AGENT][NEUTRAL] And then you needed benefits is it for outpatient or?
[CUSTOMER][NEUTRAL] Right, yeah.
[CUSTOMER][NEUTRAL] Mm
[CUSTOMER][NEUTRAL] Uh yeah. I want to check on the uh 3 medications.
[AGENT][NEUTRAL] For a medication?
[CUSTOMER][NEUTRAL] Yeah, new medication.
[AGENT][NEUTRAL] Um, let's see.
[CUSTOMER][NEUTRAL] I
[CUSTOMER][NEUTRAL] Mhm
[CUSTOMER][NEUTRAL] Mhm
[CUSTOMER][NEUTRAL] Mhm
[AGENT][NEUTRAL] Um, she does have an outpatient drug benefit of $10 per day.
[AGENT][NEUTRAL] And a maximum of 15 days per calendar year.
[CUSTOMER][NEUTRAL] Mm, OK, [PII], uh, I just want to confirm, like, uh, which medication you are talking about for like a $1. That is, uh, we have two medications here uh Zompi, Regoy, and the bounce. So which medication?
[AGENT][NEUTRAL] We, it doesn't specify medication. It's just a flat outpatient prescription medication benefit for $10. That's all it will pay is $10.
[CUSTOMER][NEUTRAL] 8.
[CUSTOMER][NEUTRAL] Oh, OK.
[CUSTOMER][NEUTRAL] Uh-huh. So you mean uh there's no specific uh medication that it is required, right?
[AGENT][NEUTRAL] No, no, no specific medication.
[CUSTOMER][NEUTRAL] Uh-huh. Oh, OK, I get it. So, but I want to know this as well, is the patient coverage active for this number?
[AGENT][NEUTRAL] Yes, it's active.
[CUSTOMER][NEUTRAL] Mhm. OK. So, uh, is the patient plan government-funded or commercial?
[AGENT][NEUTRAL] It's a supplemental policy.
[CUSTOMER][NEUTRAL] Mhm. OK. All right. So for the medication, uh, there's no specific things like that, right? So, uh, but it shows here that, uh, we have 3 medications. That's why I was asking you regarding about it.
[AGENT][POSITIVE] Yeah, it's just a $10 benefit. It's for, it doesn't matter what medication it is.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Mm
[CUSTOMER][NEUTRAL] So like, oh, OK, I'm just a little confused here.
[AGENT][NEUTRAL] So it will pay $10.
[CUSTOMER][NEUTRAL] There's no specific medication?
[AGENT][NEUTRAL] No, it's outpatient prescription drug benefit and that it will pay $10 per day with a max of 15 days per covered year or person per calendar year. So it doesn't, we don't have a specific list of medications that are required.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Mhm
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Mm
[CUSTOMER][NEUTRAL] So you can't able to find any medication which I gave it to you, right?
[AGENT][NEUTRAL] Yeah, it, there is no list of medications. It's for any medication.
[CUSTOMER][NEUTRAL] I know
[AGENT][NEUTRAL] It will just pay $10.
[CUSTOMER][NEUTRAL] Hm
[CUSTOMER][NEUTRAL] Mhm
[CUSTOMER][NEUTRAL] And
[CUSTOMER][NEUTRAL] But uh just in case, uh, like, um,
[CUSTOMER][NEUTRAL] Which I gave you the 3 medication by any chance for this number, that would be uh like uh covered or like prior authorization needed or a planned exclusion. Any ideas about that?
[AGENT][NEUTRAL] There's no prior author required?
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Oh, the 3 medications, right?
[AGENT][NEUTRAL] We don't require prior off for any medication.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][POSITIVE] Alright, I get it. Thank you so much. Uh, and [PII], may I know your last initial name?
[AGENT][NEUTRAL] It's [PII] and last initial is [PII].
[CUSTOMER][POSITIVE] Mhm. OK. Thank you so much, [PII]. And may I know your reference ID for this call?
[AGENT][NEUTRAL] It'll it'll just be my first name, last initial and then today's date.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][POSITIVE] OK, thank you so much, [PII] and for giving me this information.
[AGENT][POSITIVE] OK, thank you, [PII]. I hope you have a great day and thank you for calling APL.
[CUSTOMER][NEUTRAL] Yeah, you too. Bye.
[AGENT][NEUTRAL] Bye.