AccountId: 011433970860
ContactId: 2b8fef6e-b7ee-4249-85c8-a8ae82e1b6bc
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 238660 ms
Total Talk Time (AGENT): 91671 ms
Total Talk Time (CUSTOMER): 112017 ms
Interruptions: 1
Overall Sentiment: AGENT=1.3, CUSTOMER=0.5
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/01/21/2b8fef6e-b7ee-4249-85c8-a8ae82e1b6bc_20250121T20:39_UTC.wav
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[AGENT][NEUTRAL] Hi, thank you for calling APL. This is [PII]. How can I help you today?
[CUSTOMER][NEUTRAL] Hello, my name is [PII] and I'm calling because I need to check if a patient is active. Also, the network status and if pre-certification or referral is required.
[AGENT][NEUTRAL] OK, yeah, so we wanna check eligibility we wanna check network and then we want to see if pre-certification was needed.
[CUSTOMER][NEUTRAL] Yes, for a specific city code.
[AGENT][POSITIVE] Perfect. Alright, I, I'd love to help you with that. Do you mind if I snag a good callback number real quick for you?
[CUSTOMER][NEUTRAL] Yeah, it's [PII].
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] Hm
[AGENT][NEUTRAL] Thank you. And what's that member's policy number?
[CUSTOMER][NEUTRAL] It's 02280066. M as in Mary, L as in Lima, 8.
[AGENT][POSITIVE] Wonderful. And would you be able to verify please your patient's first and last name and date of birth?
[CUSTOMER][NEUTRAL] It's [PII] and date of birth is [PII].
[AGENT][NEUTRAL] Perfect. Um, I do see [PII] here, she's current and active. Her effective date is [PII].
[AGENT][NEUTRAL] Um, there is, uh, for this policy, we follow major medicals network.
[AGENT][NEUTRAL] Um, so we follow whatever happens with major medical and then because we are her secondary insurance, um, we don't need any pre-certifications or referrals.
[CUSTOMER][NEUTRAL] OK, so, uh, pre-certification is not required.
[AGENT][NEUTRAL] No.
[CUSTOMER][NEUTRAL] Thank you. Uh, I didn't understand that, uh, the network thing, so we are in network or out of network or you are like open access.
[AGENT][NEUTRAL] So we follow
[AGENT][NEUTRAL] Well yeah we don't have a network we just follow major medical so we don't, we don't have a network it's just we pay based off of what their major medical if they have benefits through them.
[CUSTOMER][NEUTRAL] OK, so you're open access.
[AGENT][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Um, OK, give me one second.
[CUSTOMER][NEUTRAL] And can you check um the network name of this member plan for example if it's PPO or HMO.
[AGENT][NEUTRAL] Um, we don't have.
[AGENT][NEUTRAL] We're just like a supplemental like insurance.
[CUSTOMER][NEUTRAL] Oh, it's the same OK.
[AGENT][NEUTRAL] I'm sorry.
[CUSTOMER][NEUTRAL] No, it's OK. Don't worry, um, just give me one second.
[CUSTOMER][NEUTRAL] OK, so just to verify, the member is active, uh, your open access and pre-certification is now required.
[AGENT][NEUTRAL] Mhm.
[AGENT][POSITIVE] Correct.
[CUSTOMER][POSITIVE] Wonderful, thank you so much. Um, OK, I think I'm just gonna need two more things. And if, uh, um, if you can please provide me your name and also your last name initial and call reference number.
[AGENT][NEUTRAL] OK, yeah, perfect. So my name is [PII], and the reference number is my name, my last initial and today's date.
[CUSTOMER][NEUTRAL] OK, uh, so your name is [PII]
[AGENT][POSITIVE] Yes, correct.
[CUSTOMER][POSITIVE] OK, thank you. OK, [PII], thank you so much for your help and I hope you have a wonderful day.
[AGENT][POSITIVE] Oh my pleasure thank you too you have a great day and thanks for calling APL.
[CUSTOMER][NEUTRAL] You too bye bye.
[AGENT][NEUTRAL] Bye bye.