AccountId: 011433970860
ContactId: 2432e304-7e77-4486-a2e2-f5c1fd88fa4f
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 429160 ms
Total Talk Time (AGENT): 139913 ms
Total Talk Time (CUSTOMER): 182100 ms
Interruptions: 0
Overall Sentiment: AGENT=0.7, CUSTOMER=0.6
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/05/09/2432e304-7e77-4486-a2e2-f5c1fd88fa4f_20250509T18:49_UTC.wav
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[AGENT][NEUTRAL] Thank you for calling APL. This is [PII]. How can I help you?
[CUSTOMER][NEUTRAL] Yeah, hi. My name is [PII] and I'm calling from provider's office, uh looking members eligibility. Could you please help us?
[AGENT][NEUTRAL] Yeah, I can check eligibility for you. Uh, right, can I get a good call back number from you first in case we're disconnected?
[CUSTOMER][NEUTRAL] Yeah, the callback number is.
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] Thank you. And do you have that policy number?
[CUSTOMER][NEUTRAL] Yeah, the policy number is 01750411.
[AGENT][NEUTRAL] OK, and what was the name and date of birth for the member, please?
[CUSTOMER][NEUTRAL] Uh member's name is [PII] Last name is [PII]
[CUSTOMER][NEUTRAL] And the date of birth is?
[CUSTOMER][NEUTRAL] [PII].
[AGENT][POSITIVE] Perfect, thank you for verifying that. So this policy is active. Effective date was [PII].
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] And for this policy, any co-pay copay coinsurance?
[AGENT][NEUTRAL] I'm sorry, what was that?
[CUSTOMER][NEUTRAL] Yeah, for this policy, any co-pay coinsurance?
[AGENT][NEUTRAL] Oh, so this is a limited indemnity medical plan.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Then no copay, no coinsurance for that, right?
[AGENT][POSITIVE] Correct.
[CUSTOMER][NEUTRAL] Yeah, OK. And for this plan, any authorization are required for this specialist office visit?
[AGENT][NEUTRAL] No authorization is not required.
[CUSTOMER][NEUTRAL] Authorization is not required.
[CUSTOMER][NEUTRAL] Uh, yeah, OK. And uh can you please, uh,
[CUSTOMER][NEUTRAL] Mm, for this plan, the policy type is like commercial HMO PPO, which policies.
[AGENT][NEUTRAL] Um,
[AGENT][NEUTRAL] No, it's, it's a limited indemnity medical plan, so it pays a set dollar amount for covered procedure and office visit.
[CUSTOMER][NEUTRAL] Yeah, OK. Like uh commercial policy. And can you please provide me the claim mailing address for this plan?
[AGENT][NEUTRAL] Yes, that is [PII].
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] And that is in [PII]?
[CUSTOMER][NEUTRAL] Yeah, just, just a second.
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] You
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] [PII].
[AGENT][NEUTRAL] [PII].
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] That is in [PII], [PII].
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] Yes, [PII]. Uh, zip code is [PII].
[CUSTOMER][NEUTRAL] Yeah, can you please provide me one time the zip code [PII].
[AGENT][NEUTRAL] I'm what was that? I'm sorry?
[CUSTOMER][NEUTRAL] Uh, can you please provide the one's time, the zip code?
[AGENT][NEUTRAL] The zip code?
[CUSTOMER][NEUTRAL] Yes.
[AGENT][NEUTRAL] [PII].
[AGENT][NEUTRAL] [PII].
[CUSTOMER][NEUTRAL] Yeah, OK. And can you please provide me with the electronic claim mailing address, sorry, claim mailing ID?
[AGENT][NEUTRAL] I, yes, that is 60801.
[CUSTOMER][NEUTRAL] Electronic payer ID 60801, right?
[AGENT][POSITIVE] Correct.
[CUSTOMER][POSITIVE] Yeah, OK. Thank you for that.
[CUSTOMER][NEUTRAL] Claim will be submitted for [PII] Hoohoma, right?
[AGENT][NEUTRAL] It's, um, no, no, no, so it's, it's 248,950.
[CUSTOMER][NEUTRAL] Yeah, 2,489,500.
[AGENT][NEUTRAL] Yes.
[CUSTOMER][NEUTRAL] Yeah, and uh can you please uh provide me the pair name for this?
[CUSTOMER][NEUTRAL] Like, uh, APL, right?
[AGENT][NEUTRAL] Oh,
[AGENT][NEUTRAL] Yes, yes, ATL.
[CUSTOMER][NEUTRAL] Yeah, but as for the member ID card, uh, patient medical benefits, uh, submitted claim to like AIMINC [PII].
[AGENT][NEUTRAL] Right, so that is this is a part of a um multi plan. So this is our uh claim information is the address I just gave you and our payer ID.
[CUSTOMER][NEUTRAL] Can you please recheck it?
[CUSTOMER][NEUTRAL] Yeah, this uh mm plan will be submitted for this claim, right?
[AGENT][NEUTRAL] Mhm. Yes.
[CUSTOMER][NEUTRAL] Yeah. Then this plan um
[CUSTOMER][NEUTRAL] Claim is not rejected for the multiplan.
[AGENT][NEUTRAL] It's part of a multi plan that was the address that you have.
[CUSTOMER][NEUTRAL] I
[AGENT][NEUTRAL] For IMA.
[CUSTOMER][NEUTRAL] Yeah, OK.
[CUSTOMER][NEUTRAL] Yeah, OK, I am me.
[CUSTOMER][POSITIVE] Yeah, OK, no problem.
[CUSTOMER][NEUTRAL] And uh can you please uh spell your name for me?
[AGENT][POSITIVE] Yes, it's [PII]. Was there anything else I could help you with today?
[CUSTOMER][NEUTRAL] [PII], right?
[AGENT][NEUTRAL] Yes, [PII].
[CUSTOMER][NEUTRAL] And the first of your last name?
[CUSTOMER][NEUTRAL] And can you please provide me the call reference number?
[AGENT][NEUTRAL] Reference number would just be my first name, last initial, and today's date.
[CUSTOMER][NEUTRAL] Yeah, OK, no problem. And uh one more question for this IPL any IPA is found?
[AGENT][NEUTRAL] Could you repeat that? I'm sorry.
[CUSTOMER][NEUTRAL] Any independent position.
[CUSTOMER][NEUTRAL] Any I pay for this plan?
[AGENT][NEUTRAL] Um, I'm sorry, any what for the plan?
[CUSTOMER][NEUTRAL] Uh, IP independent physician.
[AGENT][NEGATIVE] Oh, no.
[CUSTOMER][NEUTRAL] No. And uh one more question.
[CUSTOMER][NEUTRAL] Just a second. And can you please uh confirm the provider is contracted or not? Yeah, out of network, yeah, in network?
[AGENT][NEUTRAL] This policy as it is a limited indemnity medical plan is not affiliated with any network, but it could be used anywhere. The claim information would just be sent to us.
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][POSITIVE] Yeah, OK, no problem.
[CUSTOMER][POSITIVE] OK, thank you.
[AGENT][POSITIVE] Of course, thanks for calling [PII] have a great rest of your day.
[CUSTOMER][POSITIVE] Have a great day. Bye-bye.
[AGENT][POSITIVE] Thank you. Bye-bye.