AccountId: 011433970860
ContactId: 3ab18fb1-c223-45ac-a1f3-164baf2d470b
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 290760 ms
Total Talk Time (AGENT): 111358 ms
Total Talk Time (CUSTOMER): 102970 ms
Interruptions: 0
Overall Sentiment: AGENT=0.6, CUSTOMER=1
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/01/21/3ab18fb1-c223-45ac-a1f3-164baf2d470b_20250121T20:04_UTC.wav
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[AGENT][NEUTRAL] Thank you for calling APL. This is [PII]. How can I help you?
[CUSTOMER][NEUTRAL] Hi, good, uh, good morning, [PII]. My name is [PII] calling from the office of Doctor Soo Rheumatology. I'm calling to verify eligibility on a patient.
[AGENT][NEUTRAL] I'm sure, [PII], I can assist you with benefits. Um, first, I'll need a good callback number just in case we're disconnected.
[CUSTOMER][NEUTRAL] Direct line, no extension, it's area code [PII].
[AGENT][NEUTRAL] Thank you. Now, I need the policy number, please.
[CUSTOMER][NEUTRAL] Policy number is 0257949 the letters M as in Mary, L as in Lima, and I think that is in.
[CUSTOMER][NEUTRAL] Mm and 8 ML 8.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] OK, could you please repeat that number?
[CUSTOMER][NEUTRAL] Sure it's 0257949, the letters M as in Mary, L as in Lima 8.
[AGENT][NEUTRAL] Mhm. OK, no one's coming up under that number. Do you have the social?
[CUSTOMER][NEUTRAL] I, I do not.
[AGENT][NEUTRAL] OK, I can look them up by name and date of birth. What's the last name?
[CUSTOMER][NEUTRAL] Uh
[CUSTOMER][NEUTRAL] Last name is [PII]
[CUSTOMER][NEUTRAL] First name is [PII].
[AGENT][NEUTRAL] And is this a medical or dental policy?
[CUSTOMER][NEUTRAL] Medical?
[AGENT][NEUTRAL] Mm
[AGENT][NEUTRAL] Mhm.
[AGENT][NEUTRAL] OK. [PII]. OK, no one's coming up under that name.
[CUSTOMER][NEUTRAL] Or maybe his first name um is [PII].
[AGENT][NEUTRAL] [PII]
[CUSTOMER][POSITIVE] Correct, [PII]
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] And his date of birth?
[CUSTOMER][NEUTRAL] It's [PII].
[AGENT][NEUTRAL] OK, I found him in our system. Let me give you his policy number.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] The policy number is 025.
[AGENT][NEUTRAL] 79497.
[AGENT][NEUTRAL] OK. And just let me advise you that verification of coverage does not guarantee payment of claims. Um, the effective date on this policy was [PII] and the policy is still active.
[AGENT][NEUTRAL] Um, is this for inpatient or outpatient benefits or an office visit?
[CUSTOMER][NEUTRAL] A patient will be coming in for a specialist office visit.
[AGENT][NEUTRAL] OK, for services provided in office, we cover up to $500 per day and that's for the co-insurance and the deductible after the primary insurance processes the claim, but the co-pay for the office visit is not covered.
[CUSTOMER][NEUTRAL] OK, so this is a secondary insurance?
[AGENT][NEUTRAL] Yes, ma'am.
[CUSTOMER][NEUTRAL] OK and then what um.
[CUSTOMER][NEUTRAL] What is the claims mailing address for professional claims?
[AGENT][NEUTRAL] Um, the address is [PII].
[AGENT][NEUTRAL] [PII].
[AGENT][NEUTRAL] And that's in [PII].
[AGENT][NEUTRAL] [PII]
[CUSTOMER][NEUTRAL] I'm so sorry, [PII].
[AGENT][NEUTRAL] [PII].
[CUSTOMER][NEUTRAL] [PII] let me go ahead and repeat that. That's [PII] [PII] zip code [PII].
[AGENT][POSITIVE] Yes, ma'am. That's correct.
[CUSTOMER][POSITIVE] Perfect and then I do appreciate um for the correct policy number by chance is there a group number as well?
[AGENT][POSITIVE] Um, yes, let me get that for you.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] The group number is 20055.
[CUSTOMER][NEUTRAL] 20055 alright perfect [PII] and then by chance um do you provide call reference numbers?
[AGENT][NEUTRAL] Yes, for the reference number, you can use my name in today's date.
[CUSTOMER][POSITIVE] All right perfect I appreciate your time and your patience have a great day.
[AGENT][POSITIVE] You do the same, [PII]. Thank you for calling ATL. Have a great rest of your day. Bye.
[CUSTOMER][POSITIVE] You as well thank you bye.