AccountId: 011433970860
ContactId: 29f8c874-0569-48ce-bdd4-c052b6b7bca6
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 408470 ms
Total Talk Time (AGENT): 143135 ms
Total Talk Time (CUSTOMER): 124658 ms
Interruptions: 0
Overall Sentiment: AGENT=0.4, CUSTOMER=0.2
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/02/12/29f8c874-0569-48ce-bdd4-c052b6b7bca6_20250212T16:12_UTC.wav
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[AGENT][NEUTRAL] Thank you for calling APL. This is [PII]. How can I help you?
[CUSTOMER][NEUTRAL] Hi, I'm calling from Doctor [PII] office. I was just giving a call for one of our mutual patient to, um, check their eligibility.
[AGENT][NEUTRAL] OK, yeah, I can check eligibility for you uh what was your name?
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] OK, [PII], can I get a good call back number from you in case we're disconnected?
[CUSTOMER][NEUTRAL] Yeah, um, [PII].
[AGENT][NEUTRAL] Thank you and then do you have the policy number?
[CUSTOMER][NEUTRAL] Policy number 1 2nd.
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Policy number.
[CUSTOMER][NEUTRAL] Mm, I see a group number.
[AGENT][NEUTRAL] Are you looking at the card?
[CUSTOMER][NEUTRAL] Yeah
[AGENT][NEUTRAL] Um, at the bottom do you see, uh, anything that says inpatient or out or excuse me, in hospital or outpatient certification number?
[CUSTOMER][NEUTRAL] Mm.
[AGENT][NEUTRAL] Or a member ID or something like that?
[CUSTOMER][NEUTRAL] It's an employee ID.
[CUSTOMER][NEUTRAL] Is that the one?
[AGENT][NEUTRAL] Um, does the card say APL or American Public Life?
[CUSTOMER][NEUTRAL] Um, it's saying let me see.
[CUSTOMER][NEUTRAL] No, it's a 90 degree benefits or multi plan.
[AGENT][NEUTRAL] Ah, OK.
[AGENT][NEUTRAL] OK, so then it wouldn't have any of our information on there uh do you maybe have their social? I could search for them that way.
[CUSTOMER][NEUTRAL] I don't think I have their social on file.
[CUSTOMER][NEUTRAL] Mm
[CUSTOMER][NEUTRAL] I just have their employee ID number. I think that's their member ID number if you wanna try that and the group number.
[AGENT][NEUTRAL] Um, that's all going to be through 90 degrees, so I wouldn't be able to search our system with that information. Um, if you don't have their social, the only other thing I could try is, uh, with their first and last name, uh, if you don't mind spelling out the first and last name for me.
[CUSTOMER][NEUTRAL] Oh got you.
[CUSTOMER][NEUTRAL] Yeah, sure.
[CUSTOMER][NEUTRAL] Um, first name is [PII]. That's the first name.
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] And then last name is [PII].
[AGENT][NEUTRAL] OK thank you one moment.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] OK, and this was for medical correct?
[CUSTOMER][NEUTRAL] Yes.
[AGENT][NEUTRAL] OK, uh do you have the date of birth for this number?
[CUSTOMER][NEUTRAL] Date of birth um [PII].
[AGENT][NEUTRAL] OK perfect so I did find their policy [PII], um, it is active. The effective date was [PII] and if you'd like I can go ahead and give you the policy number that they have with us.
[CUSTOMER][NEUTRAL] Give me one second, let me put a note on here.
[CUSTOMER][NEUTRAL] You say active um what date again?
[AGENT][NEUTRAL] Mhm.
[AGENT][NEUTRAL] Uh [PII].
[CUSTOMER][NEUTRAL] [PII].
[CUSTOMER][NEUTRAL] OK, and what is the policy number?
[AGENT][NEUTRAL] It is 02.
[AGENT][NEUTRAL] 58
[AGENT][NEUTRAL] 7041.
[CUSTOMER][NEUTRAL] Expiration and what is their cover for the um primary care?
[AGENT][NEUTRAL] Oh, give me just a moment let me get those benefits pulled up here. So this is a limited indemnity medical plan, so it is obviously limited, um, and pays a set dollar amount per covered procedure or office visit. Bear with me just a moment, I'll get that policy pulled up and we'll take a look look at that.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] [PII] [PII].
[CUSTOMER][NEUTRAL] 30% off [PII] for details.
[AGENT][NEUTRAL] And was this for, is it like a wellness visit?
[CUSTOMER][NEUTRAL] Yeah, you wanna come in for an um an annual physical.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] Mm
[CUSTOMER][NEUTRAL] get it.
[AGENT][NEUTRAL] Bear with me just a moment.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] OK, so this policy does not have a wellness benefit.
[CUSTOMER][NEUTRAL] OK
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] So what is his coverage for his um medical?
[AGENT][NEUTRAL] Sure.
[AGENT][NEUTRAL] So, um, of course, I will let you know verification of coverage is not a guarantee of payment for claims. Uh, this policy has, um, hospital admission benefit, hospital consignment, um, accident and sickness, uh, surgery benefit, and then a diagnostic testing benefit. So, uh, medical imaging tests, uh, advanced studies, and follow-up tests. And that is the extent of his coverage.
[CUSTOMER][NEUTRAL] OK, got you.
[CUSTOMER][POSITIVE] All right thank you so much.
[AGENT][NEUTRAL] Yeah, was there anything else I can help you with?
[CUSTOMER][NEUTRAL] No, that's it.
[AGENT][POSITIVE] Alright, well thanks for calling HP [PII]. I hope you have a great rest of your day.
[CUSTOMER][POSITIVE] You as well thank you.
[AGENT][POSITIVE] Thank you, bye bye.
[CUSTOMER][NEUTRAL] Mhm bye.