AccountId: 011433970860
ContactId: 0e25c416-3890-4bee-9ffd-fccc25ed482b
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 399179 ms
Total Talk Time (AGENT): 120293 ms
Total Talk Time (CUSTOMER): 203858 ms
Interruptions: 5
Overall Sentiment: AGENT=0.4, CUSTOMER=0.2
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/03/10/0e25c416-3890-4bee-9ffd-fccc25ed482b_20250310T18:22_UTC.wav
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[AGENT][NEUTRAL] Thank you for calling APL. This is [PII]. How may I help you?
[CUSTOMER][NEUTRAL] Hi, um, good afternoon, my name is [PII]. I'm calling from a provider's office. I need to, I need help understanding the patient's benefits, uh.
[AGENT][NEUTRAL] Excuse me, I'm sorry, I couldn't hold that in.
[CUSTOMER][POSITIVE] It's OK bless you, bless you.
[AGENT][NEUTRAL] On the patient's benefits, OK, I can help you, [PII]. You said your name is [PII]? OK, what's the, what's the policy number?
[CUSTOMER][NEUTRAL] Mhm, yes, yes, [PII], um, the policy number is.
[CUSTOMER][NEUTRAL] Mm, well, the card has the in hospitals and the outpatient medicine number. I'm guessing you need the outpatient benefit number certification number.
[AGENT][NEUTRAL] So the num the number before the letter M should be the same for each, so just give me the number before the letter L.
[CUSTOMER][NEUTRAL] And and
[CUSTOMER][NEUTRAL] Before the letter M, the the numbers before.
[AGENT][NEUTRAL] Mhm.
[AGENT][NEUTRAL] Yes.
[CUSTOMER][NEUTRAL] 1261895.
[AGENT][POSITIVE] Thank you and what's a good phone number in case we're disconnected?
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] OK, and you said you're checking for eligibility and benefits or claim status?
[CUSTOMER][NEUTRAL] Uh, yes, eligibility and benefits.
[AGENT][NEUTRAL] Is this for service in a doctor's office?
[CUSTOMER][NEUTRAL] Yes, specialist office mhm.
[AGENT][NEUTRAL] OK.
[AGENT][POSITIVE] Thank you.
[CUSTOMER][NEUTRAL] on Monday.
[AGENT][NEUTRAL] And the patient's name and date of birth?
[CUSTOMER][NEUTRAL] It's [PII] [PII].
[CUSTOMER][NEUTRAL] OK
[AGENT][NEUTRAL] OK. So I'm showing an effective date of [PII].
[AGENT][NEUTRAL] Um, let's see.
[CUSTOMER][NEUTRAL] That is
[CUSTOMER][POSITIVE] The doctor with all the results yeah.
[CUSTOMER][NEUTRAL] Get the uh get the referral.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] One moment.
[CUSTOMER][NEUTRAL] Other than that they will reschedule your appointment.
[CUSTOMER][NEUTRAL] Yeah
[CUSTOMER][NEUTRAL] So, um, what I need to know specifically in case it's gonna be easier for you is, is, um, it's if this gap insurance covers, um, home sleep studies for the patient like if it covers the the copayment from the primary insurance.
[AGENT][NEUTRAL] Yeah, the policy you gave me is not active, so I'm trying to see if they have an active policy. It turned [PII].
[CUSTOMER][NEUTRAL] Mm.
[AGENT][NEUTRAL] One moment.
[CUSTOMER][NEUTRAL] It's not
[CUSTOMER][NEUTRAL] Right here as well.
[CUSTOMER][NEUTRAL] Wait one more.
[CUSTOMER][NEUTRAL] Some more
[CUSTOMER][NEUTRAL] But something English. The next one is Spanish.
[CUSTOMER][NEUTRAL] And I see that you skipped the no show policy you.
[CUSTOMER][NEUTRAL] The no show policy?
[AGENT][NEUTRAL] And I'm sorry, [PII], you said it's for, did you say it's for a sleep study or DME?
[CUSTOMER][NEUTRAL] Yeah, uh, no home sleep study.
[AGENT][NEUTRAL] Yeah.
[AGENT][NEUTRAL] Yeah, which it is, so are you calling, you said the specialist office visit?
[CUSTOMER][NEUTRAL] cancellation
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] So let me see.
[CUSTOMER][NEUTRAL] Yeah, uh, the patient is taking home a home sleep study, and I want to know if this gap insurance covers, um, whatever his responsibilities with the first insurance, the co-payment.
[AGENT][NEUTRAL] Mhm.
[AGENT][POSITIVE] Mhm. Mhm. I got, I got it. Thank you.
[CUSTOMER][NEUTRAL] For the.
[CUSTOMER][NEUTRAL] One time one day.
[CUSTOMER][NEUTRAL] next week and next week.
[CUSTOMER][NEUTRAL] Yeah, but they had to say around 116 120.
[CUSTOMER][NEUTRAL] 115
[CUSTOMER][NEUTRAL] Uh, you have another name I want you.
[CUSTOMER][NEUTRAL] [PII]
[CUSTOMER][NEUTRAL] 1.
[CUSTOMER][NEUTRAL] Oh wait wait
[AGENT][NEUTRAL] OK, and so under the policy, um, it's not gonna be covered, uh, under this particular policy.
[CUSTOMER][NEUTRAL] Well I'm trying to
[CUSTOMER][NEUTRAL] So is does he have an active policy or he doesn't?
[AGENT][NEUTRAL] He doesn't, um, so.
[CUSTOMER][NEUTRAL] 31st yeah.
[AGENT][NEUTRAL] The the current policy, the one that you gave me, it hasn't been officially termed. There's a future lapse date on it which was [PII], um.
[CUSTOMER][NEUTRAL] Well, I want the bridge on too long.
[AGENT][NEUTRAL] But it hasn't been officially termed, but it, it will be termed. That's why I told you it's not active because this is for a future date, isn't it?
[CUSTOMER][NEUTRAL] Yeah, so.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Um, yes, it would be probably this month.
[AGENT][NEUTRAL] Mhm. Mhm.
[CUSTOMER][NEUTRAL] And when is the when is the last date? [PII].
[AGENT][NEUTRAL] Uh-huh.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] Yes, ma'am.
[CUSTOMER][NEUTRAL] It shouldn't it be, it shouldn't it be done already if the.
[AGENT][NEUTRAL] It is, it, it is, it is, that's, yeah, it is. It's no longer active as of [PII].
[CUSTOMER][NEUTRAL] 7
[CUSTOMER][NEUTRAL] Um.
[CUSTOMER][NEGATIVE] And even if it was then the it still does not cover.
[AGENT][NEGATIVE] It still would not be covered under this policy. No, ma'am.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] OK, OK, I got it. Can you just give me a reference card number? I would appreciate that.
[AGENT][NEUTRAL] Use my name in today's date as your reference, [PII] First initial and last name is [PII]. And did you have any other questions?
[CUSTOMER][NEUTRAL] OK
[CUSTOMER][POSITIVE] That will be all thank you so much appreciate it.
[AGENT][POSITIVE] You're welcome. Thanks for calling APL [PII]. Have a good day.
[CUSTOMER][NEUTRAL] You too bye.