AccountId: 011433970860
ContactId: 2ad816b7-0967-4634-b200-1ef26a916d8c
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 680000 ms
Total Talk Time (AGENT): 350131 ms
Total Talk Time (CUSTOMER): 216770 ms
Interruptions: 4
Overall Sentiment: AGENT=0.6, CUSTOMER=0.2
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/02/24/2ad816b7-0967-4634-b200-1ef26a916d8c_20250224T18:45_UTC.wav
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[AGENT][NEUTRAL] Good afternoon. Thank you for calling APL. This is [PII]. How can I help you?
[CUSTOMER][NEUTRAL] Hi, [PII]. My name is [PII]. Last initial S. I'm calling from Piedmont Hospital here in [PII], and I'm calling to verify if the patient is active for the APL.
[AGENT][NEUTRAL] Yes, I am.
[AGENT][NEUTRAL] OK, [PII], so you're only needing to get eligibility. You don't need benefit information, is that correct?
[CUSTOMER][NEUTRAL] Well, she wanted me to ask you to if the service that she's gonna be having, is it gonna be covered under the American Public Life?
[AGENT][NEUTRAL] OK, so I can try and help you with this, [PII]. So first off, what is a good callback number for you in case we're disconnected?
[CUSTOMER][NEUTRAL] Uh-huh, it's [PII].
[AGENT][POSITIVE] Thank you and the member's policy number please.
[CUSTOMER][NEUTRAL] Uh-huh, it's D as in David, 43732456.
[AGENT][NEUTRAL] OK, now that is a 90 degree benefit number for um 90 degrees. That is not an APO policy number. Does she also have a policy with American Public Life? Some of these people do.
[CUSTOMER][NEUTRAL] Yeah, she's
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] So I can't look her information up with that, uh, number. Do you?
[CUSTOMER][NEUTRAL] Um, yeah, she pulled out a car.
[CUSTOMER][NEUTRAL] Can you with her, they
[AGENT][NEUTRAL] I can't search by, I can't search by date of birth. I can try and search by the name. Do you happen to have her full social?
[CUSTOMER][NEUTRAL] A date of birth?
[CUSTOMER][NEUTRAL] Uh, yeah, let me go back and get that. Mhm.
[AGENT][NEUTRAL] OK, that would be the most effective means if you have it.
[CUSTOMER][NEUTRAL] Yeah, yeah, let me see.
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEGATIVE] So, oh good lord, I don't even have a social in here. Can I put you on hold for a second?
[AGENT][NEUTRAL] Alright, well, let's just, oh yeah, sure. I don't mind.
[CUSTOMER][NEUTRAL] Hold on.
[AGENT][POSITIVE] OK. You're welcome.
[CUSTOMER][POSITIVE] Thank you.
[CUSTOMER][NEUTRAL] OK, so her social is [PII].
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] Uh-huh.
[CUSTOMER][NEUTRAL] [PII]
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] [PII]
[AGENT][NEUTRAL] All right, thank you. So give me just a moment to see if I can locate a policy for her. OK.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Mm, OK.
[AGENT][NEUTRAL] OK, and again, that's [PII]. Is that correct?
[CUSTOMER][NEUTRAL] Yes, ma'am.
[AGENT][NEUTRAL] OK, so she does not have any coverage with American Public Life. There's no one in our system with that social. I can try by the name, but the social is the most.
[AGENT][NEUTRAL] Um, official. What's the
[CUSTOMER][NEUTRAL] OK. Her, her first name is [PII].
[AGENT][NEUTRAL] [PII] or [PII] or neither?
[CUSTOMER][NEUTRAL] Uh-huh.
[CUSTOMER][NEUTRAL] Uh-huh, yep, that's right. And last name is [PII]. No, [PII] is the first name.
[AGENT][NEUTRAL] Which one?
[AGENT][NEUTRAL] Oh.
[AGENT][NEUTRAL] I know, but so how you feel it?
[CUSTOMER][NEUTRAL] And then [PII] so like.
[AGENT][NEUTRAL] How does she spell [PII]? Cause there's multiple ways.
[CUSTOMER][NEUTRAL] Uh-huh. It's [PII]
[AGENT][NEUTRAL] And again, the last name you said is [PII]?
[CUSTOMER][NEUTRAL] Uh [PII], mhm.
[AGENT][NEUTRAL] All right. So we'll search by that. It's gonna take that a couple of months because that's a, you know, such a common name.
[CUSTOMER][NEUTRAL] Oh yeah.
[CUSTOMER][POSITIVE] Uh, no, I know, I'm sorry.
[AGENT][NEUTRAL] But we
[AGENT][NEUTRAL] But it sounds like
[AGENT][NEUTRAL] She only has a policy with 90 degree benefits, which is the D number.
[AGENT][NEUTRAL] That you gave me.
[CUSTOMER][NEUTRAL] Yeah, she yeah, she, yeah, mhm, and so what does that mean?
[AGENT][NEUTRAL] Is that what she said?
[AGENT][NEUTRAL] OK, well, I'm with American Public Life. This is a, we're two different companies. Some of these members have dual coverage, but did you call [PII]?
[CUSTOMER][NEUTRAL] Yeah, she said it has a.
[CUSTOMER][NEUTRAL] Um, [PII] and what was it?
[AGENT][NEUTRAL] [PII].
[CUSTOMER][NEUTRAL] [PII] so that's the this that's the number I need to call?
[AGENT][NEUTRAL] Is that the number you called to reach me today?
[CUSTOMER][NEUTRAL] Uh, I've called 4 numbers. I, I don't, I think the.
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Yeah, your number is [PII], right?
[AGENT][NEUTRAL] No, that's benefits and a card.
[CUSTOMER][NEUTRAL] OK, so the [PII] is the number I need to.
[AGENT][NEUTRAL] My number
[AGENT][NEUTRAL] Yes, I'm just trying to make sure you have the correct number. When the [PII] will take you to multiple places depending on which option you select.
[CUSTOMER][NEUTRAL] OK, OK.
[AGENT][NEUTRAL] And
[AGENT][NEUTRAL] So you need option 1 for 90 degree benefits. What state does she live in?
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] She lives in um [PII].
[AGENT][NEUTRAL] Yes. There's no one.
[CUSTOMER][NEUTRAL] No, I'm sorry, she lives in [PII]. There's [PII].
[AGENT][NEUTRAL] And who's the primary policy holder?
[CUSTOMER][NEUTRAL] Uh, she is.
[AGENT][NEUTRAL] No, she's not.
[AGENT][NEUTRAL] I don't think so.
[CUSTOMER][NEUTRAL] She's not
[AGENT][NEUTRAL] I have located a policy, but there's someone else showing as the primary.
[AGENT][NEGATIVE] That's why I couldn't find her by her social because she's not the primary subscriber. Ask her who the primary insured is because that's why I couldn't locate her.
[CUSTOMER][NEUTRAL] Uh,
[CUSTOMER][NEUTRAL] Let me see.
[CUSTOMER][NEUTRAL] Is that [PII]?
[AGENT][NEUTRAL] That is who we show.
[CUSTOMER][NEUTRAL] Yeah, that's her spouse.
[AGENT][NEUTRAL] OK, so the policy is in his name and she's covered under his policy. She's not the primary.
[CUSTOMER][NEUTRAL] OK. OK. Mhm.
[AGENT][NEUTRAL] OK, so just a moment.
[AGENT][NEUTRAL] So any information that I provide for you, [PII] will be a verification of benefits and not a guarantee of payment. What is her date of birth?
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Uh, [PII].
[AGENT][POSITIVE] OK, thank you
[AGENT][NEUTRAL] So this hospital indemnity limited benefit plan is active?
[AGENT][NEUTRAL] With an effective date of [PII].
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] Again this is not major medical insurance it is a limited benefit plan. So what type of benefit information are you needing for her inpatient, outpatient or office?
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Right.
[CUSTOMER][NEUTRAL] Well, yes, it's an outpatient. It is a 3D um mam uh diagnostic bilateral mammogram.
[AGENT][NEUTRAL] OK. So that is not covered under this plan.
[CUSTOMER][NEUTRAL] OK, all right, uh, that's what I needed to know and she wanted to know that too.
[AGENT][NEUTRAL] Yes, ma'am. Now, she may, you may want to speak to someone at 90 Degree Benefits, which I'll be happy to connect you with, um, to see if it's covered by that part of her plan that she has. But on this plan, that is not one of the covered diagnostic tests.
[CUSTOMER][NEUTRAL] No, that's OK. Mm mm.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][POSITIVE] OK well I thank you so much and you have a blessed safe day.
[AGENT][NEUTRAL] Well, yes, ma'am, you too. And, um, did I give you the policy number for this policy?
[CUSTOMER][NEUTRAL] Um, what is it?
[AGENT][NEUTRAL] 2573937.
[CUSTOMER][NEUTRAL] Uh-huh.
[CUSTOMER][NEUTRAL] OK, so it's 2573937.
[AGENT][NEUTRAL] Yes, and then the 90 degree benefit number is the D number that you gave me.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] She would have separate benefits under that policy. Mhm.
[CUSTOMER][NEUTRAL] Right.
[CUSTOMER][NEUTRAL] 00, so I do need to call them then at the [PII].
[AGENT][NEUTRAL] Mhm.
[AGENT][NEUTRAL] Yes, ma'am. I can transfer you if you want to verify of what's covered under that particular plan that she has. Cause again, these are two separate plans.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Oh, OK, I understand.
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK, yes ma'am. Mhm, yes ma'am.
[AGENT][NEUTRAL] All right. Well, would you like for me to connect you?
[CUSTOMER][NEUTRAL] Yes ma'am.
[AGENT][POSITIVE] I'll be happy to do that [PII]. So thank you again for calling APL and I hope you have a great afternoon.
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] And you too, you too.
[AGENT][POSITIVE] Thank you so much. All right, so one moment please.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Thank you for calling 90 Degree Benefits, the administrator for benefits in a card members. Please select from the following options to ensure you are direct.
[CUSTOMER][NEUTRAL] 9 degree Benefits, this is [PII]. How can I help you?
[AGENT][NEUTRAL] Uh, what says [PII] again.
[CUSTOMER][NEUTRAL] Hi.
[AGENT][NEUTRAL] Hi. OK.
[AGENT][NEUTRAL] So, this is another caller and I have verified the benefits for the
[CUSTOMER][NEUTRAL] OK.
[AGENT][POSITIVE] Finally, when we finally located it. Anyway, I've helped her with OPL portion. Um, the lady's name is [PII], she's real nice. She's with the provider. Her phone number is [PII].
[AGENT][NEUTRAL] And the D number she initially gave me is [PII].
[CUSTOMER][NEUTRAL] Mm.
[AGENT][NEUTRAL] And it's for part 2.
[AGENT][NEUTRAL] Um, uh, [PII].
[CUSTOMER][NEUTRAL] Part two.
[CUSTOMER][NEUTRAL] OK, yeah.
[AGENT][NEUTRAL] Yeah, for the spouse.
[CUSTOMER][NEUTRAL] All right.
[AGENT][POSITIVE] All righty. Well, are you ready? OK, thank you so much, [PII]. All right, have a good one. Bye.
[CUSTOMER][NEUTRAL] I got her pulled up.
[CUSTOMER][POSITIVE] Yes, ma'am, I am. Thank you. You're welcome. Have a good one. Thanks, you too. Bye.
[AGENT][POSITIVE] You too. Talk to you later. I'll talk to you in a few minutes.
[CUSTOMER][NEUTRAL] All right. Probably so.
[CUSTOMER][NEUTRAL] That's OK.
[AGENT][NEUTRAL] OK, OK, bye.
[CUSTOMER][NEUTRAL] All right, bye.