AccountId: 011433970860
ContactId: 0e4fa3c0-4d53-4801-99b7-4f5316681ab0
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 174800 ms
Total Talk Time (AGENT): 77357 ms
Total Talk Time (CUSTOMER): 66102 ms
Interruptions: 0
Overall Sentiment: AGENT=1.6, CUSTOMER=1
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/05/30/0e4fa3c0-4d53-4801-99b7-4f5316681ab0_20250530T20:01_UTC.wav
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[AGENT][POSITIVE] Good afternoon. Thank you for calling APL. My name is [PII]. How may I help you?
[CUSTOMER][NEUTRAL] Hi, yes, I was calling to see if our doctors or any of our providers are in network with this policy or really like what it is we have a patient here asking if we take it, but I've never seen it, so I'm not sure.
[AGENT][POSITIVE] OK, well, I can help you with the eligibility and benefits. May I have your name and a good contact number in case we're disconnected?
[CUSTOMER][NEUTRAL] Yes, my name is [PII], and the phone number is [PII].
[AGENT][NEUTRAL] Thank you. And may I have the member's policy number?
[CUSTOMER][NEUTRAL] 14527.
[AGENT][NEUTRAL] That may be the group number. Hold on one moment.
[CUSTOMER][NEUTRAL] I have a certificate number.
[AGENT][NEUTRAL] Yes, the certificate number. Yes, that's the policy number.
[CUSTOMER][NEUTRAL] OK, 022598-02.
[AGENT][NEUTRAL] Thank you, hold on one moment.
[AGENT][NEUTRAL] And can you verify the member's first and last name and date of birth?
[CUSTOMER][NEUTRAL] Oh, [PII], um, I, his date of birth isn't on this insurance certificate certificate of schedule of benefits.
[CUSTOMER][NEUTRAL] Are you able to tell us if our doctors are just are in network with this policy without, I mean.
[CUSTOMER][NEUTRAL] Cos
[AGENT][NEUTRAL] Um, hold on one moment, let me.
[CUSTOMER][NEUTRAL] The patient had emailed us
[AGENT][NEUTRAL] It's OK. Hold on one moment.
[AGENT][NEUTRAL] So for this particular policy, there is no network, um, so it's unusual and customary, so it's percentages. Um, did you need a copy of the fax back faxed to you?
[CUSTOMER][POSITIVE] Yes please.
[AGENT][NEUTRAL] OK, what's a good fax number for you?
[CUSTOMER][NEUTRAL] [PII]
[CUSTOMER][NEUTRAL] [PII]
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] Alright, so on the fax back you'll see the calendar year max and deductible, all the percentages, the waiting periods, but the waiting period has already been um satisfied as a year from when it was um became eligible. You'll see all the frequencies, all the exclusions, all the ways to file a claim, and then there's a list of covered codes. If the code you're looking for is not on this list, it wouldn't be covered by the policy.
[CUSTOMER][NEUTRAL] Mhm
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Um, and then, um, I have one more question is what are the like coordination of benefits do you guys, um, because this member has this policy and then a savings or discount plan policy.
[AGENT][NEUTRAL] Yes, there's no coordinate.
[CUSTOMER][NEUTRAL] So I don't know if we could, we could do both.
[AGENT][NEUTRAL] Of benefits, we'll we'll process the claim as we receive it.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][POSITIVE] Alrighty.
[AGENT][NEUTRAL] All right, well, was there anything else I can assist you with today?
[CUSTOMER][POSITIVE] Sounds good.
[CUSTOMER][NEUTRAL] Nope, that's gonna be it.
[AGENT][POSITIVE] Alright, [PII], well, thank you so much for calling [PII]. I hope you have a good day.
[CUSTOMER][POSITIVE] Thank you you too.
[AGENT][POSITIVE] Thank you. Bye-bye.
[CUSTOMER][NEUTRAL] Bye bye.