AccountId: 011433970860
ContactId: 0d198865-8fb6-4ffa-8576-7dc9e2e53baf
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 343570 ms
Total Talk Time (AGENT): 158957 ms
Total Talk Time (CUSTOMER): 124872 ms
Interruptions: 1
Overall Sentiment: AGENT=0.4, CUSTOMER=1.3
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2024/12/30/0d198865-8fb6-4ffa-8576-7dc9e2e53baf_20241230T16:26_UTC.wav
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[AGENT][NEUTRAL] Thank you for calling APL. This is [PII]. How can I help you?
[CUSTOMER][NEUTRAL] Hi, [PII]. My name is [PII]. I'm calling from Baptist Outpatient Services in regards of a patient that's coming in to do an exam on [PII]. I just wanna see the benefits or if the benefits will be the same for the next coming year.
[AGENT][NEUTRAL] Mhm.
[AGENT][NEUTRAL] Yeah, we can take a look at those benefits [PII]. uh, can I get a good call back number from you first in case we're disconnected?
[CUSTOMER][NEUTRAL] Of course. It's gonna be [PII].
[AGENT][NEUTRAL] OK, thank you. And then do you have the policy number?
[CUSTOMER][NEUTRAL] Um, from what I understood, they told me it was 60801.
[AGENT][NEUTRAL] Because that's actually our uh payer ID um do you maybe have their it's, it happens all the time it's the biggest thing on the card, so I think they think that's their policy um do you have their social I could search for them that way.
[CUSTOMER][POSITIVE] Oh my goodness.
[CUSTOMER][NEUTRAL] Let me see if I can find your social. I have [PII].
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] [PII]
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] OK thank you one moment.
[AGENT][NEUTRAL] And what was the name for the insured?
[CUSTOMER][NEUTRAL] Um, it's under his wife's name, which is uh [PII]
[AGENT][NEUTRAL] OK, um.
[AGENT][NEUTRAL] I'm not seeing anyone with that social in our system. It could be a mistake on our part though, um.
[AGENT][NEUTRAL] Could you spell, uh, I have [PII], is that the first name?
[CUSTOMER][NEUTRAL] Yeah, mhm.
[AGENT][NEUTRAL] OK, what was the last name?
[CUSTOMER][NEUTRAL] And last name, [PII].
[AGENT][NEUTRAL] OK, give me just a moment. I'm gonna try searching just using the name.
[CUSTOMER][NEUTRAL] OK, that's fine.
[AGENT][NEUTRAL] What state do they live in [PII]?
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] OK, um, I don't see anyone with that name in our system.
[CUSTOMER][NEUTRAL] Oh no. OK. Yeah, because that, I think that, like I said, I think it's the husband.
[CUSTOMER][NEUTRAL] Um, but it's like a family. Let me see if I can find the husband's name.
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] By any chance, um, his last, I'm guessing it just the, the, the patients, no, sorry, the.
[CUSTOMER][NEUTRAL] The pair. It's [PII]
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] And last name [PII]
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] One moment.
[AGENT][NEUTRAL] OK, well, what was the date of birth for [PII]?
[CUSTOMER][NEUTRAL] Mm, that's, that's the thing I don't know.
[CUSTOMER][POSITIVE] I'm trying to find that out right now for you.
[AGENT][NEUTRAL] Oh, that's OK. I think I have the insured, um.
[AGENT][NEUTRAL] I think I have the insured um.
[CUSTOMER][NEUTRAL] Cause I have the, the group number.
[AGENT][NEUTRAL] Do you have a date of birth for the member you're going to be seeing?
[CUSTOMER][NEUTRAL] I don't know if that helps in any way.
[CUSTOMER][NEUTRAL] Um, yes, I have that one. It's [PII].
[AGENT][NEUTRAL] OK, yeah, thank you for verifying that. So we've got her with a different last name and her name is spelled um [PII]
[AGENT][NEUTRAL] But we have it as [PII] as the last name.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] OK, so all right well we got it we're fine and I do have that correct policy number um let me know when you're ready for that.
[CUSTOMER][POSITIVE] Mhm. Perfect.
[CUSTOMER][NEUTRAL] Yes, please.
[AGENT][NEUTRAL] OK it is 02.
[AGENT][NEUTRAL] 33
[AGENT][NEUTRAL] 6092.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Perfect. OK. And then the group number is still the same, right? 25921?
[AGENT][NEUTRAL] Yes.
[AGENT][NEUTRAL] Uh, let me check that.
[CUSTOMER][NEUTRAL] That's the one that they gave me. I'm not sure.
[AGENT][NEUTRAL] 25921, yes.
[CUSTOMER][POSITIVE] Yes, perfect, perfect.
[AGENT][NEUTRAL] That is correct. OK, yes, so this policy is active, uh, effective date was [PII], and it is a secondary medical policy that is designed to help with co-pay, deductible and co-insurance after major medical pays, and was it the outpatient benefit we were needing to take a look at?
[CUSTOMER][NEUTRAL] Yes, yes, it is.
[AGENT][NEUTRAL] OK, give me just a moment, of course I will let you know verification of coverage is not a guaranteed payment for claims.
[AGENT][NEUTRAL] So their outpatient benefit is on a per calendar day basis, so it is uh $250 max per calendar day.
[CUSTOMER][NEUTRAL] OK. So it's only $200 that um the uh APO will cover, right?
[AGENT][NEUTRAL] 250 per calendar day, yes.
[CUSTOMER][NEUTRAL] OK, 250. OK, perfect, perfect. And um do you guys give a reference numbers by any chance?
[AGENT][NEUTRAL] Yeah, mhm, it would just be my first name, last initial, and today's date and so my name is spelled [PII] Was there anything else I could help you with, [PII]?
[CUSTOMER][POSITIVE] No, I think that's about it. Thank you so much for all your help today.
[AGENT][POSITIVE] OK, yeah, of course, yeah, glad we were able to find it. Thanks for calling ACL. Hope you have a happy [PII].
[CUSTOMER][POSITIVE] Yeah, thank you.
[CUSTOMER][POSITIVE] You too. Thank you. Bye-bye.
[AGENT][POSITIVE] Thank you. Bye-bye.