AccountId: 011433970860
ContactId: 3c6ab680-e8ef-416c-9ca5-d2398c4e3888
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 468579 ms
Total Talk Time (AGENT): 189407 ms
Total Talk Time (CUSTOMER): 121146 ms
Interruptions: 0
Overall Sentiment: AGENT=0.8, CUSTOMER=0.5
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/02/04/3c6ab680-e8ef-416c-9ca5-d2398c4e3888_20250204T14:52_UTC.wav
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[AGENT][NEUTRAL] Good morning. Thank you for calling APL. This is [PII]. How may I assist you?
[CUSTOMER][NEUTRAL] Hi, my name is [PII] with AdventHealth. I'm calling to check on eligibility.
[AGENT][POSITIVE] OK, sure, I can assist you with eligibility.
[AGENT][NEUTRAL] OK, and may I have a callback number just in case we get disconnected Miss [PII].
[CUSTOMER][NEUTRAL] [PII]
[AGENT][NEUTRAL] OK, thank you. And may I have the patient's policy number, Miss [PII]?
[CUSTOMER][NEUTRAL] Uh, let me make sure that they sent that over to me um.
[CUSTOMER][NEUTRAL] How many numbers is it usually?
[AGENT][NEUTRAL] It starts with the 0 followed by 7 digits, sometimes it has an ML.
[CUSTOMER][NEUTRAL] Because this was something just the patient.
[CUSTOMER][NEUTRAL] Cause I just have 6.
[CUSTOMER][NEUTRAL] I just have 60801.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] Oh, that's her payer ID.
[CUSTOMER][NEUTRAL] That's what they gave us.
[AGENT][NEUTRAL] And the phone number they gave you?
[CUSTOMER][NEUTRAL] Oh.
[CUSTOMER][NEUTRAL] Yes.
[AGENT][NEUTRAL] Mm, yeah, that is the payer ID, um.
[AGENT][NEUTRAL] Let me do a name search. Bear with me just a second. Let me pull another system for that.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] OK, let me have the spelling of the last name.
[CUSTOMER][NEUTRAL] It's [PII]
[AGENT][NEUTRAL] The spelling of the first name.
[CUSTOMER][NEUTRAL] It's [PII]
[AGENT][POSITIVE] Thank you.
[AGENT][NEUTRAL] Do you have an address for Ms. [PII]?
[CUSTOMER][NEUTRAL] Let me check.
[CUSTOMER][NEUTRAL] We have [PII].
[AGENT][NEUTRAL] Try.
[AGENT][NEUTRAL] OK. And um what is her date of birth?
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] OK, bear with me let me make another search.
[AGENT][NEUTRAL] Do you know if she's the main holder of the policy?
[CUSTOMER][NEUTRAL] Uh, I do not know that. No.
[AGENT][NEUTRAL] Mm.
[AGENT][NEUTRAL] OK, let me try this other one.
[CUSTOMER][NEUTRAL] I have a group number she gave us.
[AGENT][NEUTRAL] OK, what's the group number?
[CUSTOMER][NEUTRAL] 256-76.
[AGENT][POSITIVE] OK. Thank you.
[AGENT][NEUTRAL] OK, let me try that group because yeah, I'm not finding her with the names.
[AGENT][NEUTRAL] And she didn't go with any other last names, just [PII]?
[CUSTOMER][NEUTRAL] I see one,
[CUSTOMER][NEUTRAL] [PII].
[CUSTOMER][NEUTRAL] That's also on here.
[AGENT][NEUTRAL] Mm
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] I know, let me try that.
[CUSTOMER][NEUTRAL] Yeah, I know it's her other insurance, her primary, she goes by the last name of what I just said, [PII]
[AGENT][POSITIVE] Yeah, OK. Yeah, I think I found her.
[AGENT][NEUTRAL] Um, let me
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] 624 71, yeah, that's OK, found her, yes, she's on Sun [PII].
[AGENT][NEUTRAL] Um,
[AGENT][NEUTRAL] OK, so you said you need um eligibility information, correct, Miss [PII]?
[CUSTOMER][NEUTRAL] I just need to know if she was active on [PII].
[AGENT][NEUTRAL] Oh, OK. Uh yes.
[CUSTOMER][NEUTRAL] And then her member ID.
[AGENT][NEUTRAL] Sure. Yeah, let me start off by giving you the policy number. Let me know when you're ready.
[CUSTOMER][POSITIVE] I'm ready.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] Policy number is 02.
[AGENT][NEUTRAL] 41.
[AGENT][NEUTRAL] 9500. Again, that's 02419500. Effective date [PII].
[AGENT][NEUTRAL] It is active at the moment and this is one of our secondary supplemental plan to the major medical.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] All right, um,
[CUSTOMER][NEUTRAL] And that is the correct uh group number I gave you 256-76.
[AGENT][POSITIVE] Yes, the group number is correct, yes. Mhm.
[CUSTOMER][NEUTRAL] OK, and where do the claims go to?
[AGENT][NEUTRAL] Claims goes to APL or American Public Life, and that's [PII].
[AGENT][NEUTRAL] [PII], [PII].
[AGENT][NEUTRAL] And the zip code is [PII].
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Alright, now is there anything I'm trying to think if there's anything else I need to know to send over a claim.
[CUSTOMER][NEUTRAL] Um,
[AGENT][NEUTRAL] Yeah, we need um the claim form, um, and then we need the EOB from the primary insurance showing how much they applied towards the deductible co-payment or co-insurance.
[CUSTOMER][NEUTRAL] OK, and do you have a payer ID?
[AGENT][NEUTRAL] We do, um,
[AGENT][NEUTRAL] We do, which is the one that she gave you as a policy number. Um, now this policy, uh, yeah, needs that you'll be attached to it, so if you cannot send it electronically, it can be sent by fax or mail. I can give you a fax number if you need it.
[CUSTOMER][NEUTRAL] Uh-huh.
[CUSTOMER][NEUTRAL] Yes, what's the fax number?
[AGENT][NEUTRAL] It's [PII].
[CUSTOMER][NEUTRAL] [PII]
[AGENT][POSITIVE] Yes, that is correct.
[CUSTOMER][NEUTRAL] OK, and can I have your name and a reference number?
[AGENT][NEUTRAL] My name is [PII]. That's S [PII]. Last initial is [PII], and we don't have reference numbers. You can use my name in today's date.
[CUSTOMER][POSITIVE] OK, alright, thank you very much I appreciate it.
[AGENT][POSITIVE] You're welcome and thank you for calling APO. Have a good day.
[CUSTOMER][POSITIVE] Thanks you too bye bye.
[AGENT][POSITIVE] Thank you.