AccountId: 011433970860
ContactId: 386e8b04-82c6-4121-ba74-bf5a37ee2ddb
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 564669 ms
Total Talk Time (AGENT): 238049 ms
Total Talk Time (CUSTOMER): 180263 ms
Interruptions: 1
Overall Sentiment: AGENT=0.7, CUSTOMER=0.4
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/04/23/386e8b04-82c6-4121-ba74-bf5a37ee2ddb_20250423T17:14_UTC.wav
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[AGENT][NEUTRAL] Thank you for calling APL. This is [PII]. How can I help you?
[CUSTOMER][NEUTRAL] Yes, uh, good afternoon. I'm calling from a provider's office. I need benefits and eligibility. I'm a member, please.
[AGENT][NEUTRAL] Sure, I can check eligibility and benefits for you. Uh, what was your name, please?
[CUSTOMER][NEUTRAL] My name is [PII].
[AGENT][NEUTRAL] OK, and [PII], can I get a good call back number from you in case we're disconnected?
[CUSTOMER][NEUTRAL] Sure. It's [PII].
[AGENT][NEUTRAL] Thank you. And do you have that policy number?
[CUSTOMER][NEUTRAL] Yes, it's um 01884552.
[CUSTOMER][NEUTRAL] M as in Mary, L as in Larry, the number 8.
[AGENT][NEUTRAL] OK, and uh what was the name and date of birth for the number please?
[CUSTOMER][NEUTRAL] Sure. The name is [PII]. Date of birth is [PII].
[AGENT][NEUTRAL] OK, um, I think I might have misheard you, [PII]. I'm so sorry. Could you repeat that policy number for me?
[CUSTOMER][NEUTRAL] Sure. It's 018.
[CUSTOMER][NEUTRAL] 845
[CUSTOMER][NEUTRAL] 52
[CUSTOMER][NEUTRAL] M as in Mary, L as in Larry, 8, the number 8.
[AGENT][NEUTRAL] OK, OK, so I'm not getting a result for [PII] when I put in that information it's for a different member, uh, that is no longer active, um, do you, let's see, do you maybe have her social I could search for her that way?
[CUSTOMER][NEUTRAL] Uh, let me check if I could do that. Hold on.
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] I'm getting, I'm trying to get into the system, so just bear with me for a second. Thank you.
[AGENT][NEUTRAL] Oh you're fine. Sure, you're fine.
[CUSTOMER][NEUTRAL] So with that member ID number that I provided you, it's not coming up as her policy number?
[AGENT][NEUTRAL] It's not, um, and let me just verify for good measure, the numbers before the M that was 01884552.
[CUSTOMER][POSITIVE] Correct.
[AGENT][NEUTRAL] OK yeah that's not who I am getting.
[CUSTOMER][NEUTRAL] OK, let's see. OK, I'm in now, so let me just, let me see if I can.
[AGENT][NEUTRAL] Sure.
[CUSTOMER][NEUTRAL] Um
[AGENT][NEUTRAL] If uh you're not able to find the social, [PII], I can search um if you wouldn't mind spelling out uh the insured's first and last name, I can try that as well.
[CUSTOMER][NEUTRAL] Sure. Um the last name is [PII]
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] The first name is [PII], which is [PII].
[AGENT][NEUTRAL] OK, [PII], would you mind repeating that first name for me? I'm sorry.
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] Uh-huh.
[CUSTOMER][NEUTRAL] [PII]
[CUSTOMER][NEUTRAL] [PII].
[CUSTOMER][NEUTRAL] [PII].
[CUSTOMER][NEUTRAL] [PII].
[AGENT][POSITIVE] OK, OK, thank you one moment.
[CUSTOMER][NEUTRAL] Yeah, I'm looking at her records and um she did not indicate the social security number on file.
[AGENT][NEUTRAL] That's OK. Um, what state does she live in?
[CUSTOMER][NEUTRAL] [PII]
[AGENT][NEUTRAL] Soda, OK, I think I might have found her.
[AGENT][NEUTRAL] Let's see. Yes, OK.
[CUSTOMER][NEUTRAL] Oh, OK, she gave you, she gave you the phone number. OK, I have it here. I think it's [PII].
[AGENT][NEUTRAL] Yes, that's it and I was able to find it. OK, I appreciate that. One moment and so yes, you already verified her info at this, um, let me check all of these actually, yes, OK, so the policy is active, um, effective date was [PII].
[AGENT][NEUTRAL] And this is a secondary medical policy.
[AGENT][NEUTRAL] Oh, I'm so sorry. I apologize. Uh, effective date was [PII]. Sorry about that, um, and so as this is a secondary medical policy, it is designed to help with co-pay, deductible and co-insurance after major medical pays, and we really need to look at inpatient or outpatient benefits.
[CUSTOMER][POSITIVE] Correct.
[CUSTOMER][NEUTRAL] That's OK.
[CUSTOMER][NEUTRAL] Outpatient, so you said it, it covers co-pay, deduct, and co-insurance?
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] Yes, after major medical pays, um, and of course I will let you know verification of coverage is not a guarantee of payment for claims, uh, so the outpatient benefit is $7900 per calendar year if you'll give me one moment, I'll see if any of that has been used.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] OK, so she has used, let's see, I am not good at math. Give me just a moment.
[AGENT][NEUTRAL] So she has used um oh well that's never mind so she's only used $50 of that outpatient benefit.
[CUSTOMER][NEUTRAL] That's OK, no.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Outpatient benefits. OK, perfect. So, um, let me ask you something because with her primary parents and she has Aetna.
[AGENT][NEUTRAL] Sure.
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] And she has a co-pay plus she also has a deductible. Um, the deductible she hasn't met yet.
[AGENT][NEUTRAL] Yes.
[CUSTOMER][NEUTRAL] So, if whatever
[CUSTOMER][NEUTRAL] Um, Aetna does not pay.
[CUSTOMER][NEUTRAL] Then her secondary American public wouldn't pay or, or it would not pay?
[AGENT][NEUTRAL] Yes, yeah, so, right, all we would really need is the explanation of benefits from Aetna showing what went towards co-pay deductible or co-insurance, and then this policy will help with that until of course the calendar year maximum has um been met or has reached its limit.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK
[CUSTOMER][NEUTRAL] OK, but she doesn't have like with American, she doesn't have no deductible, no co-pay or anything like that.
[AGENT][NEGATIVE] No. Correct.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK, OK. And the address, where do I submit the claims to?
[AGENT][NEUTRAL] Yes, I've got a mailing address, a fax number, and a payer ID I can give you, um, so our, our mailing.
[CUSTOMER][NEUTRAL] OK. I need all.
[AGENT][NEUTRAL] I'm sorry?
[CUSTOMER][NEUTRAL] I said I need all 3 if you don't mind.
[AGENT][NEUTRAL] Absolutely, of course. OK, so our mailing address is [PII].
[AGENT][NEUTRAL] [PII].
[AGENT][NEUTRAL] And that is in [PII].
[AGENT][NEUTRAL] Zip code is the zip is [PII].
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] And then our fax number that is [PII].
[AGENT][NEUTRAL] 365.
[AGENT][NEUTRAL] 942 3.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] Alright, and that payer ID is 60801.
[CUSTOMER][POSITIVE] Perfect
[CUSTOMER][NEUTRAL] Um, let me just repeat the fax. It's [PII].
[AGENT][NEUTRAL] Sure.
[AGENT][POSITIVE] That's correct.
[CUSTOMER][NEUTRAL] And the payer ID is 60801.
[AGENT][NEUTRAL] Yes ma'am, that's it.
[CUSTOMER][NEUTRAL] OK, and you can fax the explanation of benefits um also to this fax number that you provided me.
[AGENT][POSITIVE] Yes, you can absolutely send that information through that fax.
[CUSTOMER][POSITIVE] OK, perfect. OK, wonderful. Thank you so much for your time I appreciate it.
[AGENT][POSITIVE] Yeah, absolutely. Was there anything else I could help you with?
[CUSTOMER][NEUTRAL] No, that would be all.
[AGENT][POSITIVE] All right, well thanks for giving us a call, [PII]. You too, thank you. Bye bye.
[CUSTOMER][NEUTRAL] You have yourself.
[CUSTOMER][NEUTRAL] Yeah