AccountId: 011433970860
ContactId: 11e83712-bb39-46da-b32d-4b6e6989f35c
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 326230 ms
Total Talk Time (AGENT): 97296 ms
Total Talk Time (CUSTOMER): 232917 ms
Interruptions: 7
Overall Sentiment: AGENT=0.5, CUSTOMER=0.6
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/04/23/11e83712-bb39-46da-b32d-4b6e6989f35c_20250423T13:37_UTC.wav
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[AGENT][NEUTRAL] Thank you for calling APL. This is [PII]. How may I help you?
[CUSTOMER][NEUTRAL] Hi, good morning. I'm calling from provider's office to check benefits please on one of my patients. I have you listed as a secondary insurance.
[AGENT][POSITIVE] Yes, of course, I can help you with benefits today. Do you have the policy number?
[CUSTOMER][NEUTRAL] I have it as um.
[CUSTOMER][NEUTRAL] Oh, I see the group but I don't see the policy.
[AGENT][NEUTRAL] It should say like member ID or policy cert.
[CUSTOMER][NEUTRAL] I got.
[CUSTOMER][NEUTRAL] Um
[CUSTOMER][NEUTRAL] Outpatient benefit certificate number.
[AGENT][NEUTRAL] No, it should say member ID or policy cert on it.
[CUSTOMER][NEUTRAL] Mm, I have insured coverage group effective day plan in-hospital benefit and outpatient benefit. Uh oh.
[AGENT][NEUTRAL] Do you see that?
[AGENT][NEUTRAL] Mm.
[AGENT][NEUTRAL] Oh, what's their first and last name?
[CUSTOMER][NEUTRAL] Um.
[CUSTOMER][NEUTRAL] [PII], first name and the last name is [PII]
[AGENT][NEUTRAL] OK, I'll look her up that way. Just a second.
[CUSTOMER][POSITIVE] Thank you, I have a date of birth if that helps you also. OK.
[AGENT][NEUTRAL] Mhm.
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEGATIVE] Oh, in here, I don't, I didn't receive anything.
[AGENT][NEUTRAL] OK, sorry, just a minute, my computer's thinking.
[CUSTOMER][POSITIVE] No problem.
[AGENT][NEUTRAL] OK
[AGENT][NEUTRAL] OK. And then what's her date of birth?
[CUSTOMER][NEUTRAL] [PII].
[CUSTOMER][NEUTRAL] Yeah.
[AGENT][NEUTRAL] OK, perfect. I found her. Um her policy is number 235.
[AGENT][NEUTRAL] 7655.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] 235-7655 and this is an HMO or PPO, a POS.
[AGENT][NEUTRAL] Mhm.
[AGENT][NEUTRAL] Um, let me see.
[AGENT][NEUTRAL] So it just says that this is a meddling policy.
[CUSTOMER][NEUTRAL] At that time
[CUSTOMER][NEUTRAL] Are you I, I wanna ask you something, OK? The call center didn't open for today at [PII].
[AGENT][NEUTRAL] Um,
[CUSTOMER][NEUTRAL] A new page, of course not verified the that was, it was [PII]. The tax was 10 years to 552.
[CUSTOMER][NEUTRAL] How did you expect me to verify the patient?
[CUSTOMER][NEUTRAL] I mean we already do right now at [PII].
[AGENT][NEUTRAL] OK. And then are you looking for outpatient or inpatient benefits?
[CUSTOMER][NEUTRAL] OK
[CUSTOMER][NEUTRAL] Medical outpatient.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] OK, this is not a guarantee of payment. It's just the verification.
[CUSTOMER][NEUTRAL] The patient is really her son.
[AGENT][NEUTRAL] Her son, OK. Let me go back really quick.
[CUSTOMER][NEUTRAL] [PII].
[CUSTOMER][NEUTRAL] Mhm
[AGENT][NEUTRAL] OK, and then what's his date of birth?
[CUSTOMER][NEUTRAL] Yes
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEGATIVE] Uh, but I thought, I thought that was something that I hate.
[AGENT][NEUTRAL] OK, this is not a guarantee of payment, it's just a verification of coverage. So it looks like for their policy they have an outpatient benefit max per calendar year and that is $750.
[CUSTOMER][NEUTRAL] I have.
[CUSTOMER][NEUTRAL] Today I the patient, OK, well, does it say anything there that they let the patient know?
[AGENT][NEUTRAL] And that's also for office treatment as well.
[CUSTOMER][NEUTRAL] So they only have $750?
[AGENT][NEUTRAL] Yes, per calendar.
[AGENT][NEUTRAL] Sorry, per calendar day.
[CUSTOMER][NEUTRAL] We have a doctor.
[CUSTOMER][NEUTRAL] Have they met anything used anything?
[AGENT][NEUTRAL] Mm let me check for you.
[CUSTOMER][NEUTRAL] Sure.
[CUSTOMER][POSITIVE] Well see that's awesome.
[CUSTOMER][NEGATIVE] No, no.
[AGENT][NEUTRAL] OK, they have not used anything this year.
[CUSTOMER][POSITIVE] Fantastic, and in [PII] is the address. OK, if I could please have your name and a reference number for the call, thank you very much for your help.
[AGENT][NEUTRAL] Mhm.
[AGENT][NEUTRAL] Yes, of course. My name is [PII]
[CUSTOMER][NEUTRAL] I
[AGENT][NEUTRAL] And the reference number will be my first name.
[CUSTOMER][NEUTRAL] I
[AGENT][NEUTRAL] Last initial [PII] and today's date.
[CUSTOMER][POSITIVE] Good morning.
[CUSTOMER][NEUTRAL] So that
[CUSTOMER][POSITIVE] 42325 fantastic, [PII], you have a wonderful rest of your day. Thank you for your help.
[AGENT][POSITIVE] Yeah, thanks for calling APO. Have a good day.
[CUSTOMER][POSITIVE] You too thank you bye bye.
[AGENT][POSITIVE] OK. Thank you. Bye.