AccountId: 011433970860
ContactId: 549b7251-eceb-4b54-b957-771d26e97140
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 266239 ms
Total Talk Time (AGENT): 114146 ms
Total Talk Time (CUSTOMER): 94706 ms
Interruptions: 0
Overall Sentiment: AGENT=1.1, CUSTOMER=1
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/04/23/549b7251-eceb-4b54-b957-771d26e97140_20250423T13:47_UTC.wav
--------------------------------------------
[AGENT][NEUTRAL] Thank you for calling APL. This is [PII]. How can I help you?
[CUSTOMER][NEUTRAL] Hi, I'm calling to verify eligibility please.
[AGENT][POSITIVE] Um, yes, ma'am. I can assist you with benefits. Um, first, could I get your name and a good callback number just in case we're disconnected?
[CUSTOMER][NEUTRAL] Um, yes, my name is [PII]
[CUSTOMER][NEUTRAL] Initial to my last name is [PII].
[AGENT][NEUTRAL] Mhm.
[AGENT][POSITIVE] And a good callback number just in case we're disconnected.
[CUSTOMER][NEUTRAL] [PII] and I'm sorry I didn't catch your name.
[AGENT][NEUTRAL] Um my name is [PII]. Um it's spelled [PII] and my last initial is [PII].
[CUSTOMER][POSITIVE] OK, thank you.
[AGENT][POSITIVE] Mm, no problem.
[AGENT][NEUTRAL] And thank you, as [PII]. Could I get the policy number, please?
[CUSTOMER][NEUTRAL] Yes, I've got F as in Frank, C as in Charlie, O as in Oscar, H as in Hank, 450896997.
[AGENT][NEUTRAL] OK, that's not one of our policy numbers. Um, if you have the member's social or I could try to look them up by name and date of birth.
[CUSTOMER][NEUTRAL] OK, um, let me see here, let's try.
[CUSTOMER][NEUTRAL] OK, I've got the social let's try that.
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] That's gonna be [PII].
[AGENT][NEUTRAL] Mhm
[AGENT][NEUTRAL] OK. And please verify the patient's name and date of birth.
[CUSTOMER][NEUTRAL] [PII] [PII].
[AGENT][NEUTRAL] OK, thank you. I found him in our system and just let me advise you that verification of coverage does not guarantee payment of claims. Um, I have his policy number here if you need that.
[CUSTOMER][NEUTRAL] OK, go ahead when when you have that.
[AGENT][NEUTRAL] OK, the policy number is 02519342.
[CUSTOMER][NEUTRAL] 02519342
[AGENT][POSITIVE] Yes ma'am, that's correct.
[CUSTOMER][NEUTRAL] OK perfect and is this plan open?
[CUSTOMER][NEUTRAL] Um, it's eligible for billing for [PII].
[AGENT][NEUTRAL] Oh
[AGENT][NEUTRAL] OK, let's see. Yes, ma'am. The effective date on this policy was [PII] and the policy is still active. And would this be for inpatient or outpatient benefits or an office visit?
[CUSTOMER][NEUTRAL] Uh, it was for an emergency room visit.
[AGENT][NEUTRAL] OK. Yes, ma'am. That'll be covered under the outpatient benefit and for outpatient, we cover up to $500 per day. And that's for the co-pay, the co-insurance, and the deductible after the primary insurance processes the claim.
[CUSTOMER][NEUTRAL] OK. I do not have a primary insurance. Do you happen to have one listed? This is what he gave us as his only insurance.
[AGENT][NEUTRAL] Um, no, ma'am. We don't keep that on file. We actually don't know who the primary carrier is until we receive the claim from the provider because the provider will, um, along with the claim form, send the EOB from the primary insurance.
[CUSTOMER][NEUTRAL] OK, so we don't have a primary insurance. Are we able to bill you all as primary, or are you showing that you're only secondary?
[AGENT][NEUTRAL] We're only secondary.
[CUSTOMER][NEUTRAL] Got you OK alrighty I will get with the patient and see if we can get a hold of that primary insurance. Is there a call reference number by any chance?
[AGENT][NEUTRAL] Yes, for the reference number, you can use my name and today's date. Um my name is [PII]. It's spelled [PII] My last initial is [PII] and today's date. Is there anything else I can assist you with?
[CUSTOMER][POSITIVE] Uh, no, that's it for today. Thank you for your help.
[AGENT][POSITIVE] OK, thank you, as [PII], for calling APL. You have a great rest of your day. Mm bye.
[CUSTOMER][POSITIVE] You too thank you bye bye.
[AGENT][NEUTRAL] Mhm