AccountId: 011433970860
ContactId: 10e2bb7a-cb71-4da6-b3e0-15751473fb21
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 249470 ms
Total Talk Time (AGENT): 129492 ms
Total Talk Time (CUSTOMER): 67397 ms
Interruptions: 0
Overall Sentiment: AGENT=1.2, CUSTOMER=0.5
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/01/13/10e2bb7a-cb71-4da6-b3e0-15751473fb21_20250113T15:11_UTC.wav
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[AGENT][NEUTRAL] Thank you for calling APL. This is [PII] speaking. How can I help you?
[CUSTOMER][NEUTRAL] Hi, my name is [PII]. Last initial [PII] if you need it. I'm calling from a hospital to see if the member's plan is just a limited medical or they have inpatient benefits.
[AGENT][POSITIVE] Certainly [PII] I can help you with eligibility and benefits. Can I have your callback number in case we get disconnected please?
[CUSTOMER][NEUTRAL] Yes, it is [PII].
[AGENT][NEUTRAL] And may I have the name of the facility or provider's office you're calling from?
[CUSTOMER][NEUTRAL] University Health Truman Medical Center.
[AGENT][NEUTRAL] And do you have that member's policy certificate or ID number please?
[CUSTOMER][NEUTRAL] Yes, it is D as in Delta 42031358.
[AGENT][NEUTRAL] Now is that the only um number that's listed on the ID card for their policy number?
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] Yeah
[CUSTOMER][NEUTRAL] Yeah, uh, it says employee ID um.
[CUSTOMER][NEUTRAL] Here's a group number.
[CUSTOMER][NEUTRAL] And I don't so like a subscriber number. It just says employee ID employee name, medical coverage, group number, and then there's RX information.
[CUSTOMER][NEUTRAL] Um,
[AGENT][NEUTRAL] OK, let's search with um do you happen to have a social security number or we can search with name also?
[CUSTOMER][NEUTRAL] Um, social security number is [PII].
[AGENT][NEUTRAL] Let's try that and see if I can.
[CUSTOMER][NEUTRAL] And I don't know if it matters, but the, the card says 90 degree, but it has this number listed as the.
[AGENT][NEUTRAL] Right, OK.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] I just can't search with that policy number with the alpha character.
[CUSTOMER][NEUTRAL] OK
[AGENT][NEUTRAL] OK, so let me have you.
[AGENT][NEUTRAL] Verify patient's name and date of birth?
[CUSTOMER][NEUTRAL] This is for [PII]. Date of birth is [PII].
[AGENT][POSITIVE] OK thank you alright.
[AGENT][NEUTRAL] So I did locate a policy, just bear with me for one moment and then I'll explain to you also that.
[CUSTOMER][POSITIVE] No problem.
[AGENT][NEUTRAL] I am a the difference in the.
[AGENT][NEUTRAL] So we're um we process the claim third party for um.
[AGENT][NEUTRAL] IMA so they go to they go to the IMA and then IMA reports them over to us for processing, um, if they have coverage with us, but they do have a policy certificate in addition to that ID number that you provided which like I said I can't search for that. I have to search under their policy number. So just to let you know it is a verification of their coverage and not a guarantee of payment and is this for uh a current data service?
[CUSTOMER][NEUTRAL] OK
[CUSTOMER][NEUTRAL] Um, so the patient was admitted over the weekend, see, on the [PII] and discharged on the [PII].
[AGENT][NEUTRAL] OK.
[AGENT][NEGATIVE] So unfortunately this policy is no longer active and um the effective date was [PII].
[AGENT][NEUTRAL] And the policy uh shows to be lapsed as of [PII].
[AGENT][NEUTRAL] So he hasn't had coverage.
[CUSTOMER][NEUTRAL] Oh, so they haven't had coverage for quite a while.
[AGENT][NEUTRAL] Right, unfortunately, um, and I don't see any additional coverage for this member under uh under his information. Did you have any other questions, [PII]?
[CUSTOMER][NEUTRAL] OK
[CUSTOMER][NEUTRAL] Nope, that was it. Do you provide call reference numbers?
[AGENT][NEUTRAL] Certainly the call reference number you would use my name in today's date. First name is [PII].
[AGENT][POSITIVE] And the last initial [PII].
[CUSTOMER][POSITIVE] Perfect thank you so much I hope you have a great day.
[AGENT][POSITIVE] You too, [PII] thank you so much for calling APL. I hope you have a great rest of your day and a great week.
[AGENT][POSITIVE] Thank you.
[CUSTOMER][NEUTRAL] You too bye.
[AGENT][NEUTRAL] Bye bye.