AccountId: 011433970860
ContactId: 34608177-70e0-4640-b2f7-db1fe2c6c67d
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 479630 ms
Total Talk Time (AGENT): 205133 ms
Total Talk Time (CUSTOMER): 174202 ms
Interruptions: 1
Overall Sentiment: AGENT=0.8, CUSTOMER=0.4
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/01/31/34608177-70e0-4640-b2f7-db1fe2c6c67d_20250131T16:13_UTC.wav
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[AGENT][NEUTRAL] Thank you for calling APL. This is [PII]. How may I help you?
[CUSTOMER][NEUTRAL] Hello?
[CUSTOMER][NEUTRAL] Um, oh la buenos dias alata is er tengu scientes para revisarito.
[AGENT][NEUTRAL] OK, um, uh, OK, just a moment.
[CUSTOMER][NEUTRAL] F
[AGENT][NEUTRAL] Uh, do you speak English?
[CUSTOMER][NEUTRAL] Oh yes, sorry, this is [PII].
[AGENT][NEUTRAL] Oh, OK.
[CUSTOMER][POSITIVE] Good morning. I have a patient with uh
[AGENT][POSITIVE] Good morning.
[CUSTOMER][NEUTRAL] Um, with this insurance, like a secondary insurance, I need the benefits.
[AGENT][NEUTRAL] Yes.
[AGENT][POSITIVE] OK, I can help you with benefits.
[CUSTOMER][NEUTRAL] OK, so you.
[CUSTOMER][NEUTRAL] Your name is?
[CUSTOMER][POSITIVE] You got it.
[AGENT][NEUTRAL] [PII]
[AGENT][NEUTRAL] And you said your name is [PII]?
[CUSTOMER][NEUTRAL] [PII]
[CUSTOMER][NEUTRAL] Uh yes, it's [PII]
[AGENT][NEUTRAL] Oh, Tyus. OK, thank you. And my name is [PII]
[CUSTOMER][NEUTRAL] OK, sorry.
[AGENT][NEUTRAL] That's OK. um, what is your callback number just in case our call is disconnected?
[CUSTOMER][NEUTRAL] [PII], no extension.
[AGENT][POSITIVE] OK, thank you. I appreciate that. And then what is the patient's name?
[CUSTOMER][NEUTRAL] It's [PII].
[AGENT][NEUTRAL] OK, and what's [PII]'s date of birth?
[CUSTOMER][NEUTRAL] [PII].
[AGENT][POSITIVE] Thank you and [PII]'s policy number please.
[CUSTOMER][NEUTRAL] I do have 5 numbers. Um, it's 21,430. I don't know if it is wrong number, wrong policy number.
[AGENT][NEUTRAL] Correct, um, do you see an inpatient or outpatient certification number?
[CUSTOMER][NEUTRAL] Outpatient, but this is the correct uh uh sorry this is the correct member ID 21,430.
[AGENT][POSITIVE] Yes, can I have that please?
[AGENT][NEUTRAL] No, ma'am.
[CUSTOMER][NEUTRAL] Oh.
[CUSTOMER][NEUTRAL] OK. Do you have the correct number?
[AGENT][NEUTRAL] Do you have um
[CUSTOMER][NEGATIVE] Oh sorry.
[AGENT][NEUTRAL] I can, do you have the social security number? I can pull up her policy and give you the correct number with the social security number.
[CUSTOMER][NEUTRAL] Oh no, I don't have the, the social, but you don't find my date of birth and and name?
[AGENT][NEUTRAL] OK, can you spell the first name for me, please?
[CUSTOMER][NEUTRAL] Yes, name is [PII].
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] Oh, [PII], OK. [PII].
[CUSTOMER][POSITIVE] Correct.
[AGENT][NEUTRAL] Let me see if I can find.
[CUSTOMER][NEUTRAL] [PII]
[CUSTOMER][NEUTRAL] Yeah.
[AGENT][NEUTRAL] OK, what state does [PII] live in?
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] OK, do you have the address?
[CUSTOMER][NEUTRAL] Let me see. I
[CUSTOMER][NEUTRAL] [PII].
[CUSTOMER][NEUTRAL] Um, [PII].
[CUSTOMER][NEUTRAL] Let me see, one moment.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] I'm gonna look, there's a, we have many [PII]'s in our system, very many. Let me look and see if I can find them.
[CUSTOMER][NEUTRAL] Oh.
[CUSTOMER][NEUTRAL] Oh, I have, I have the phone number.
[AGENT][NEUTRAL] Oh, I think.
[AGENT][NEUTRAL] OK, wait a minute. I think I found him. You said [PII].
[CUSTOMER][NEUTRAL] Twice, yes.
[AGENT][NEUTRAL] [PII]. OK, I think I found it.
[CUSTOMER][NEUTRAL] OK, we can compare with the phone number also.
[AGENT][NEUTRAL] Um, actually, you gave me his date of birth, so that's good confirmation for us.
[CUSTOMER][POSITIVE] OK, excellent. OK, what is
[AGENT][NEUTRAL] Because phone numbers change.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] OK, I do have his policy.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] And his policy number is 23.
[AGENT][NEUTRAL] 13.
[AGENT][NEUTRAL] 728.
[AGENT][NEUTRAL] His policy is active.
[AGENT][NEUTRAL] His effective date is [PII].
[AGENT][NEUTRAL] And this is just to verify his benefits. It's not a guarantee of payment. He has a supplemental insurance policy that's billed secondary to the primary. It is a gap insurance that helps with deductible, co-pay, and co-insurance.
[CUSTOMER][NEUTRAL] Yes
[AGENT][NEUTRAL] He has an inpatient benefit amount of $6850 and then he also has an outpatient benefit amount per calendar day of $1500.
[CUSTOMER][NEUTRAL] OK. Uh, 1500. And any accumulation?
[AGENT][NEUTRAL] Let me look and see for you real quick.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] And the number, the first number you gave me that 21,430, that's actually his group number you might need to know that too.
[CUSTOMER][NEUTRAL] 0, 21,430. This is the group number.
[AGENT][NEUTRAL] Yes.
[CUSTOMER][NEUTRAL] Let me, OK.
[AGENT][POSITIVE] Yes ma'am, so that'll help, that might help you too.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK, so I have the member ID you provide to me. Thank you. And the group number.
[AGENT][NEUTRAL] Yes, and I do not show that he has used any of his benefits for the year of [PII].
[CUSTOMER][NEUTRAL] OK, an office, office visit and not covered. Correct?
[AGENT][NEUTRAL] No, uh, let me look and see.
[AGENT][NEUTRAL] But he has not used, he's not accumulated anything for [PII].
[CUSTOMER][NEUTRAL] OK. So, let me see if I have the correct information. Oh, sorry for the interruption.
[AGENT][NEUTRAL] So he still has all of his.
[AGENT][NEUTRAL] That's OK. He still has his benefits. OK, let me look for office visits.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][POSITIVE] Awesome.
[AGENT][NEUTRAL] OK, he can use his policy for ER urgent care center, MRI imaging center or an ambulatory center.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] OK, sorry, I have a question.
[CUSTOMER][NEUTRAL] Hello?
[AGENT][NEUTRAL] Mhm. Yes, I can hear you.
[CUSTOMER][NEUTRAL] OK. Um, do you have a reference number?
[AGENT][NEUTRAL] Yes, you can use my name, [PII], in today's date.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK, allow me one moment, so[PII].
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] One moment.
[AGENT][POSITIVE] You're welcome.
[CUSTOMER][POSITIVE] Thank you so much for your help, [PII]. Have a wonderful day. Happy weekend.
[AGENT][POSITIVE] You too, [PII]. Yes, have a great weekend, [PII]. We appreciate you calling [PII]. You have a blessed one. Thank. Thank you so much.
[CUSTOMER][NEUTRAL] Bye-bye.
[AGENT][NEUTRAL] Bye-bye, ma'am.