AccountId: 011433970860
ContactId: 3630f547-e1df-4e76-94a0-9cf53d6d0d2d
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 287739 ms
Total Talk Time (AGENT): 121664 ms
Total Talk Time (CUSTOMER): 121440 ms
Interruptions: 1
Overall Sentiment: AGENT=0.6, CUSTOMER=0.4
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/01/09/3630f547-e1df-4e76-94a0-9cf53d6d0d2d_20250109T14:33_UTC.wav
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[AGENT][POSITIVE] Good morning. Thank you for calling APL. This is [PII]. How may I assist you?
[CUSTOMER][NEUTRAL] Hi, good morning. What was your name?
[AGENT][NEUTRAL] My name is [PII] as well.
[CUSTOMER][NEUTRAL] Hi, so, yeah, my name is [PII]. I'm calling from the facility. I'm trying to verify the patient's um eligibility.
[AGENT][NEUTRAL] OK, sure, I can assist you with eligibility [PII]. And may I have a callback number just in case we get disconnected?
[CUSTOMER][NEUTRAL] Yes, it's [PII].
[AGENT][NEUTRAL] OK, thank you. And may I have the patient's policy number, Miss?
[CUSTOMER][NEUTRAL] Policy number, uh, would you say outpatient benefit certification number or the group number?
[AGENT][NEUTRAL] Mhm. Yes.
[AGENT][NEUTRAL] No patients aren't.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK, it's 02.
[CUSTOMER][NEUTRAL] 307628
[CUSTOMER][NEUTRAL] M as in Mary, L as in Lima, A.
[AGENT][NEUTRAL] Mm
[CUSTOMER][NEUTRAL] The number 8.
[AGENT][POSITIVE] Thank you.
[AGENT][NEUTRAL] May I have the name and date of birth of the patient?
[CUSTOMER][NEUTRAL] Is [PII], on [PII]?
[AGENT][NEUTRAL] OK. Perfect. Thank you. Right, and you said you need eligibility and we have an effective date of [PII]. Now, this particular policy terminated [PII]. Um, let me check and see if I have a new policy, OK? One moment.
[CUSTOMER][NEUTRAL] Yeah, because uh the patient was seen on November and.
[AGENT][NEUTRAL] Mhm.
[AGENT][NEUTRAL] Oh OK.
[CUSTOMER][NEUTRAL] Her insurance didn't cover, this is like a gap insurance?
[AGENT][NEUTRAL] It's a secondary supplemental plan.
[AGENT][NEUTRAL] Mhm um.
[CUSTOMER][NEUTRAL] OK, so she was seen on, on November from last year, so it would be this um.
[CUSTOMER][NEUTRAL] Account number, the one that I provide?
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] Mhm. Yes, correct. Um, what is the date of service you want me to check and see if we received any claims for that date of service?
[CUSTOMER][NEUTRAL] Yeah, date of December was [PII]. I think it didn't.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] [PII]
[AGENT][NEUTRAL] Let me check
[CUSTOMER][NEUTRAL] went to your claim.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] Yeah.
[AGENT][NEUTRAL] That is correct. Yes, we have not received that claim as of today.
[CUSTOMER][NEUTRAL] OK, but that particular day, the patient was active, you say it was active from [PII] through.
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] December last year.
[AGENT][NEUTRAL] [PII]. Correct. Mhm.
[CUSTOMER][NEUTRAL] OK, so we send the claim through this um.
[CUSTOMER][NEUTRAL] Member ID, right?
[AGENT][NEUTRAL] Correct, yes. Mhm. Do you need the address or the fax number?
[CUSTOMER][NEUTRAL] No, I have the back of the card that is saying, let me double check here.
[AGENT][NEUTRAL] OK
[CUSTOMER][NEUTRAL] Uh, submit claim to [PII]. Is that one the right one?
[AGENT][NEUTRAL] In [PII], mhm.
[CUSTOMER][NEUTRAL] Yes.
[AGENT][POSITIVE] Yes, that is correct.
[CUSTOMER][NEUTRAL] OK, perfect. Does the patient have a coverage for outpatient facility? Or does it have any amount?
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] Any amount available. OK, let me check on that. OK, and this is not a guarantee of payment, just a verification of coverage and that's just a disclaimer. And let's see.
[CUSTOMER][NEUTRAL] You
[CUSTOMER][NEUTRAL] Yeah.
[AGENT][NEUTRAL] OK, so this one had a per day benefit. The per day benefit is $500.
[CUSTOMER][NEUTRAL] $500?
[AGENT][NEUTRAL] Mhm, yes.
[CUSTOMER][NEUTRAL] And it was not met through that I, I mean, that time?
[AGENT][NEUTRAL] That day, I didn't see any claims for that date of service.
[CUSTOMER][NEUTRAL] So the patient has $500 per day, right?
[AGENT][NEUTRAL] And it's a per day. Mhm.
[AGENT][POSITIVE] Correct. Mhm. Yes.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK, so I'm gonna submit the claim, um, and forward that to to the claim department.
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Do I have any reference number for the call?
[AGENT][NEUTRAL] Mm
[AGENT][NEUTRAL] We don't have reference numbers you can use my name in today's date if you will.
[CUSTOMER][NEUTRAL] OK, and how do you spell your name you said?
[AGENT][NEUTRAL] My name is [PII]. That's [PII]. Is there anything else I'm gonna help you with today?
[CUSTOMER][POSITIVE] No, thank you so much. Have a nice day.
[AGENT][POSITIVE] You're welcome. You as well, and thank you for calling APL, Miss [PII]. bye-bye.
[CUSTOMER][POSITIVE] Thank you bye bye.
[AGENT][NEUTRAL] Mm