AccountId: 011433970860
ContactId: 4e977ee6-d9dc-4534-ba12-9c6e8bebd1e4
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 508690 ms
Total Talk Time (AGENT): 226242 ms
Total Talk Time (CUSTOMER): 231519 ms
Interruptions: 14
Overall Sentiment: AGENT=0.2, CUSTOMER=0.3
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/01/15/4e977ee6-d9dc-4534-ba12-9c6e8bebd1e4_20250115T15:16_UTC.wav
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[AGENT][NEUTRAL] Thank you for calling APL. This is [PII]. How may I help you?
[CUSTOMER][NEUTRAL] Hi [PII], yes, I was calling to check benefits and see if I need authorization please for a patient.
[AGENT][NEUTRAL] OK, yes ma'am I can help you with benefits and authorization. Can you please give me your name and your callback number?
[CUSTOMER][POSITIVE] Thank you.
[CUSTOMER][NEUTRAL] [PII] and it's [PII].
[AGENT][POSITIVE] OK, thank you Miss [PII].
[AGENT][NEUTRAL] And what is the patient's name?
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] OK. And then what is his
[CUSTOMER][NEUTRAL] [PII]
[AGENT][NEUTRAL] OK, thank you. And what is um his date of birth, please?
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] And then also his policy number?
[CUSTOMER][NEUTRAL] Um, it is, well, OK, I don't have that now. I got his 90 degree benefits number and then I called them and she said for medical to call you guys, but I, he gave us the 90 degrees card, but this is for like DME coverage that I need.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] OK. OK. And you.
[AGENT][NEUTRAL] OK. All right. So let me try to pull him in by his name. I know you spell his last name [PII] How do I spell his first name? Is it [PII]?
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] It's, it's [PII]
[AGENT][NEUTRAL] Oh Mac, I'm so sorry. OK, let me, I'm, let me go ahead and try to find him by his name.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] OK, I'm not able to find [PII]. Do you have a social security number that'll pull any policy has with us up.
[CUSTOMER][NEUTRAL] Oh.
[CUSTOMER][NEUTRAL] Mm, I don't think so. Hang on, let me, let me see what all I have.
[AGENT][NEUTRAL] Yes ma'am.
[CUSTOMER][NEUTRAL] See, let's pull it up real quick.
[CUSTOMER][NEGATIVE] This computer I swear is doing something today. Ever since I came in this morning it won't let me use my numbers. It only lets me pull up stuff by name because my number keys are not working. I don't know what the deal is. Yeah, it's very annoying.
[AGENT][NEUTRAL] Just
[AGENT][POSITIVE] Take your time.
[AGENT][NEGATIVE] Oh, no.
[AGENT][NEGATIVE] Oh no.
[AGENT][NEGATIVE] Oh no, that's horrible and you use that probably all day long. I mean, probably more than you do your keys.
[CUSTOMER][NEUTRAL] Yeah. Yes.
[CUSTOMER][NEUTRAL] Yeah and I can't figure out if I like hit a button on my keyboard or yes, yeah.
[AGENT][NEUTRAL] And it always does it when you're on the phone.
[AGENT][NEUTRAL] Uh-huh.
[CUSTOMER][NEUTRAL] OK, let's see I have a copy of his driver's license and then I got a copy of the.
[CUSTOMER][NEUTRAL] MAU workforce solutions card.
[CUSTOMER][NEUTRAL] Um, it's got pharmacy, Vision Medical.
[AGENT][NEUTRAL] What is his, do you know his group number?
[CUSTOMER][NEUTRAL] OK, group number 943 7.
[AGENT][NEUTRAL] OK, let me see if I can find him in his group.
[CUSTOMER][NEUTRAL] Um.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] Just a minute.
[CUSTOMER][NEUTRAL] And he's the 3rd on the card it says Mac [PII] 3rd.
[AGENT][NEUTRAL] OK, maybe I need to put it in that way. Let me do that.
[AGENT][POSITIVE] Ah, that's, that was the key. I got him.
[CUSTOMER][NEUTRAL] Oh, OK, yay, now can you give me his ID number? Are you allowed to?
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] And
[AGENT][NEUTRAL] Yes, I can give that to you. Uh, first, can I, what kind of facility are you?
[CUSTOMER][NEUTRAL] We're DME we're hanger clinic or hanger prosthetics and orthotics.
[AGENT][NEUTRAL] OK, so it'll be a medical.
[CUSTOMER][NEUTRAL] Yeah, I haven't seen one.
[AGENT][NEUTRAL] Um, because he has several different policies. I want to make sure I got the right one.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Yeah, it's medical mhm.
[AGENT][NEUTRAL] OK, so his um policy number is 02358541.
[CUSTOMER][NEUTRAL] I was
[CUSTOMER][NEUTRAL] That
[CUSTOMER][NEUTRAL] Yeah
[CUSTOMER][POSITIVE] Hey like like gras stuff so I can take all those off.
[AGENT][NEUTRAL] And this is just to verify his coverage. It's not a guarantee of payment. He is active and his effective date is [PII].
[AGENT][NEUTRAL] And he has a hospital indemnity plan.
[CUSTOMER][NEUTRAL] You ever heard that?
[AGENT][NEUTRAL] It's a limited benefit plan that helps um.
[CUSTOMER][NEUTRAL] Um
[AGENT][NEUTRAL] With hospital stays, it does have more benefits on it, but it pays a certain percentage of a covered procedure.
[CUSTOMER][NEUTRAL] She
[AGENT][NEUTRAL] Or a certain dollar amount I say I've covered this procedure.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Um, can I be.
[AGENT][NEUTRAL] Oh
[AGENT][NEUTRAL] He has an outpatient sickness benefit rider for sickness that pays $75.
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] OK, what about like for he just needs like a little ankle brace. Did do they cover anything like that or any of the amount of that?
[AGENT][NEUTRAL] Let me pull his complete policy up and look at it and see if it says anything about.
[CUSTOMER][NEUTRAL] So you should only
[AGENT][NEUTRAL] That
[AGENT][NEUTRAL] It's gonna be a moment while the computer pulls it up.
[CUSTOMER][NEUTRAL] OK, and is it just through American Public Life?
[CUSTOMER][NEUTRAL] Or is it through somebody else like multi plan or anything?
[AGENT][NEUTRAL] Yes.
[AGENT][NEUTRAL] It's through American Public Life.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] And let's see.
[CUSTOMER][NEUTRAL] Well, because I mean technically
[AGENT][NEUTRAL] Let me find a schedule of benefits real real quick.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Oh
[AGENT][NEUTRAL] OK. He does not have anything as far as prosthetics on it. Um, he
[CUSTOMER][POSITIVE] This is better.
[AGENT][NEUTRAL] Or so what it is is his outpatient sickness writer is for sickness only and he has $95 that pays um 5 visits per calendar year.
[CUSTOMER][NEUTRAL] Yeah.
[AGENT][NEUTRAL] And the rest of his policy is.
[CUSTOMER][NEGATIVE] OK, so they're not gonna cover any of this price then.
[AGENT][NEUTRAL] Right. The rest of this policy is for hospital admission.
[CUSTOMER][NEGATIVE] Doesn't sound like it, OK.
[AGENT][NEUTRAL] And diagnostic testing.
[CUSTOMER][NEUTRAL] Oh OK, OK.
[CUSTOMER][NEUTRAL] So it sounds like he has to pay out of pocket for his brace.
[CUSTOMER][NEUTRAL] That would be fine.
[AGENT][NEUTRAL] Right. It's not, I don't see that the brace is covered under the policy under the outpatient cause the outpatient clearly says for sickness.
[CUSTOMER][NEUTRAL] Yeah
[CUSTOMER][NEUTRAL] Right, OK.
[CUSTOMER][POSITIVE] Uh, I do that, I just, we're really surprised with that. I, I'm like.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] All right.
[CUSTOMER][NEUTRAL] Alright, so policy for sickness.
[CUSTOMER][NEUTRAL] All right.
[CUSTOMER][POSITIVE] All right. Well, that tells me, thank you so much.
[AGENT][POSITIVE] You're so very welcome, Ms. [PII]. Is there anything else I can help you with before we go?
[CUSTOMER][NEUTRAL] Mhm
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] Oh
[CUSTOMER][POSITIVE] No, that was it thank you so much.
[AGENT][POSITIVE] You're welcome and I hope your computer starts acting right for you today.
[CUSTOMER][NEGATIVE] Me too. I cannot even work.
[AGENT][NEUTRAL] I know, right?
[CUSTOMER][POSITIVE] Oh, OK. Well, thank you so much. Have a good day.
[AGENT][POSITIVE] You're welcome. You take care.
[AGENT][POSITIVE] Thank you for calling APL. You take care. Bye-bye.
[CUSTOMER][POSITIVE] You too, thanks. Thank you too. All right, bye.