AccountId: 011433970860
ContactId: 440e90f9-43d6-44f0-83e4-a18ab8c760d7
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 473549 ms
Total Talk Time (AGENT): 171179 ms
Total Talk Time (CUSTOMER): 171623 ms
Interruptions: 2
Overall Sentiment: AGENT=1, CUSTOMER=0.5
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/04/09/440e90f9-43d6-44f0-83e4-a18ab8c760d7_20250409T17:45_UTC.wav
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[AGENT][NEUTRAL] Good afternoon. Thank you for calling APL. This is [PII]. How can I help you?
[CUSTOMER][NEUTRAL] Hi, [PII]. My name is [PII]. I'm calling from provider's office to check patients medical eligibility. Is it possible to have?
[CUSTOMER][NEUTRAL] Hello?
[AGENT][NEUTRAL] OK, so [PII], you're wanting eligibility only for a member, is that correct?
[CUSTOMER][NEUTRAL] Uh, yes, I need to check medical eligibility for the member.
[AGENT][NEUTRAL] Yes, I can help you with eligibility, [PII]. And what is your callback number?
[CUSTOMER][NEUTRAL] My callback number is [PII].
[AGENT][NEUTRAL] Thank you. And what is the member's policy number, please?
[CUSTOMER][NEUTRAL] Um, the policy I have is
[CUSTOMER][NEUTRAL] 016348
[CUSTOMER][NEUTRAL] 48 M as in Mike, L as in Lima, 8.
[AGENT][NEUTRAL] Mm.
[AGENT][NEUTRAL] So it's 4848, is that correct?
[CUSTOMER][NEUTRAL] Mm, no, 4842, M as in Mike, L as in Lima, and then number 8.
[AGENT][NEUTRAL] Hm
[AGENT][NEUTRAL] A moment please.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] And any information that I provide.
[AGENT][NEUTRAL] For you today would
[CUSTOMER][NEUTRAL] Hello?
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] The a verification of benefits and not a guarantee of payment.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] What is your patient's name and date of birth?
[CUSTOMER][NEUTRAL] Patient's name is [PII]. It is
[CUSTOMER][NEUTRAL] First name is [PII]. Last name is [PII]. It is [PII]
[CUSTOMER][NEUTRAL] Date of birth [PII].
[AGENT][NEUTRAL] OK, thank you. Now this policy, she is the subscriber on this policy, but this policy number is no longer active.
[AGENT][NEUTRAL] This particular policy with.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] Back from [PII].
[CUSTOMER][NEUTRAL] Mm.
[AGENT][NEUTRAL] She does have another policy that is active. Do you need the currently active policy?
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Uh, just give me a moment. Hello?
[AGENT][NEUTRAL] Information?
[CUSTOMER][NEUTRAL] Uh, sorry for the interruption. If you don't mind, could you please provide me the termination date for this policy?
[AGENT][NEUTRAL] Yes, ma'am.
[AGENT][NEUTRAL] Again, the termination date for the policy number you gave me was [PII].
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] OK. So the member's policy got down [PII].
[AGENT][NEUTRAL] I'm sorry, what? Say that again. Yes, ma'am, repeat what you said.
[CUSTOMER][NEUTRAL] Hello?
[CUSTOMER][NEUTRAL] Uh, you said the policy.
[CUSTOMER][NEUTRAL] OK, sorry. So you said the policy got down [PII], right?
[AGENT][NEUTRAL] That is correct. And then there is another policy that was issued that is currently active.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK. If you don't mind, could you please provide me the eligibility?
[AGENT][NEUTRAL] With a different policy number?
[AGENT][NEUTRAL] That information.
[CUSTOMER][NEUTRAL] Yes.
[CUSTOMER][NEUTRAL] Yes.
[AGENT][NEUTRAL] The current active policy number is 256-8898, effective date [PII] and no termination date.
[CUSTOMER][NEUTRAL] Mm.
[CUSTOMER][NEUTRAL] Mm.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] So, the current policy with ID 256-8898?
[CUSTOMER][NEUTRAL] Uh, it is effective from [PII] and now the policy is active. There is no any termination date for that policy, right?
[AGENT][POSITIVE] That is correct.
[CUSTOMER][NEUTRAL] Hello?
[CUSTOMER][POSITIVE] Oh, thank you so much. Is there any group name and the group number for the policy?
[AGENT][NEUTRAL] Yes.
[AGENT][NEUTRAL] Group 15371.
[CUSTOMER][NEUTRAL] Could you please provide me that?
[AGENT][NEUTRAL] Again, the group number is 15371.
[CUSTOMER][NEUTRAL] Mm.
[AGENT][NEUTRAL] The name of the group is [PII].
[AGENT][NEUTRAL] Case Enterprises.
[CUSTOMER][NEUTRAL] You
[CUSTOMER][NEUTRAL] Is it [PII]?
[AGENT][NEUTRAL] Yes, ma'am. Uh-huh.
[AGENT][POSITIVE] That is correct. Yes, ma'am.
[CUSTOMER][NEUTRAL] Thank you. Um, could you please provide me your name?
[AGENT][POSITIVE] You're welcome.
[AGENT][NEUTRAL] My name you need for me to give you my name again?
[CUSTOMER][NEUTRAL] Mm
[CUSTOMER][NEUTRAL] Yes.
[AGENT][NEUTRAL] [PII]
[CUSTOMER][NEUTRAL] [PII]
[AGENT][NEUTRAL] And [PII]
[AGENT][NEUTRAL] [PII]
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][POSITIVE] [PII] Thank you, [PII].
[AGENT][NEUTRAL] And [PII], if you all were filing a claim this number.
[AGENT][NEUTRAL] You're welcome and if you all will be filing a claim on this uh member's plan, we will also have to have a copy of the primary insurance company's explanation of benefits with the claim. And then once the claim has been processed by APL, we do have a portal that you can check claim status by going to [PII].
[CUSTOMER][NEUTRAL] Mm.
[CUSTOMER][NEUTRAL] Mm.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Thank you, [PII]. If you don't mind, could you please provide me the color?
[AGENT][NEUTRAL] Well, you're
[AGENT][NEUTRAL] Yes, ma'am. It's my name along with today's date.
[CUSTOMER][NEUTRAL] OK. So the call reference is the month today's date.
[AGENT][NEUTRAL] OK.
[AGENT][POSITIVE] That is correct.
[CUSTOMER][NEUTRAL] Uh, one second, please.
[CUSTOMER][NEUTRAL] Yes, thank you for that. In the member ID, is there any uh letters like ML?
[AGENT][POSITIVE] You're welcome.
[AGENT][NEUTRAL] No ma'am.
[AGENT][NEUTRAL] Just the numbers that I gave you.
[CUSTOMER][NEUTRAL] I
[AGENT][NEUTRAL] will be all that you would need.
[CUSTOMER][POSITIVE] OK, which is 256-8898. Thank you.
[AGENT][POSITIVE] Correct. You're welcome.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] So again, is there anything else that I can help you with?
[CUSTOMER][POSITIVE] Thank you so much, [PII]. Bye.
[CUSTOMER][POSITIVE] No, it is enough for me. Thank you.
[AGENT][POSITIVE] Well, you're welcome and thank you for calling APL.
[AGENT][POSITIVE] OK, well then, thank you for calling APO [PII]. Have a nice day.
[CUSTOMER][NEUTRAL] Bye.
[CUSTOMER][POSITIVE] You too. Have a great day. Bye.
[AGENT][NEUTRAL] You too. Bye-bye.
[CUSTOMER][NEUTRAL] Mm.
[CUSTOMER][NEUTRAL] The.