AccountId: 011433970860
ContactId: 584a5f36-f2d4-4b43-a616-a7e2b2f6481d
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 345160 ms
Total Talk Time (AGENT): 166493 ms
Total Talk Time (CUSTOMER): 115772 ms
Interruptions: 0
Overall Sentiment: AGENT=0.6, CUSTOMER=0.3
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/04/07/584a5f36-f2d4-4b43-a616-a7e2b2f6481d_20250407T22:10_UTC.wav
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[AGENT][NEUTRAL] Thank you for calling APL. This is [PII]. How may I help you?
[CUSTOMER][NEUTRAL] Hi, good afternoon, sorry, my name is [PII]. I'm calling from Emerald Hills Pharmacy. We have a patient that's picking up prescriptions with us, and um, he provided me this card. I just wanted to verify because I don't see any like billing information for prescription coverage. I just wanted to verify if that was covered with his plan.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] Yes ma'am, I can look um at his benefits for you and you said your name was [PII]?
[CUSTOMER][NEUTRAL] Yes.
[AGENT][NEUTRAL] OK, Ms. [PII], what's your callback number just in case our call is disconnected?
[CUSTOMER][NEUTRAL] It is [PII].
[AGENT][NEUTRAL] Thank you, ma'am. And then what's the patient's name, date of birth, and policy number?
[CUSTOMER][NEUTRAL] Uh, so it's the policy for the family, um, on the card, it says insured is [PII]. The last name is spelled [PII]
[CUSTOMER][NEUTRAL] Um,
[CUSTOMER][NEUTRAL] Uh, your date of birth? [PII] is the date of birth?
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] And where would I find the policy number?
[AGENT][NEUTRAL] It might say inpatient certificate number or outpatient certificate number or member ID.
[CUSTOMER][NEUTRAL] OK, so inpatient benefit cert number is 01881542.
[CUSTOMER][NEUTRAL] M like Mary and L like Lincoln.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] Alright, let me look that up real quick.
[CUSTOMER][NEUTRAL] And then 7 after.
[AGENT][POSITIVE] OK, thank you so much.
[AGENT][NEUTRAL] OK, and who is the person getting the prescription?
[CUSTOMER][NEUTRAL] It would be his son, [PII].
[AGENT][NEUTRAL] [PII], OK.
[AGENT][NEUTRAL] OK, I do show that the policy is active, effective, uh, [PII], and this is just to verify benefits. It's not a guarantee of payment. Uh, let me pull in his actual policy to see if he has any kind of prescription benefits.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] Because this policy is a sup
[AGENT][NEUTRAL] Insurance policy that's billed secondary to the primary and it
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] I'm sorry, you cut off. It does what?
[CUSTOMER][NEUTRAL] Hello?
[AGENT][NEUTRAL] He has, can you hear me?
[AGENT][NEUTRAL] Sorry.
[CUSTOMER][NEUTRAL] Uh yes, I can hear you now.
[AGENT][NEUTRAL] OK, and this policy does help with deductible, co-pay and co-insurance. Um, uh, the EOB from the primary insurance will need to be sent in with the claim, but I wanna just double check and make sure he even has uh.
[AGENT][NEUTRAL] Pharmacy on this.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] So, can you hear me?
[CUSTOMER][NEUTRAL] Yes.
[AGENT][NEUTRAL] I have a um.
[CUSTOMER][NEUTRAL] Hello?
[AGENT][NEUTRAL] Can you hear me?
[CUSTOMER][NEGATIVE] You you're breaking up. It's like in and out.
[CUSTOMER][NEUTRAL] Hello?
[AGENT][NEUTRAL] OK. Hello. So, um, on this policy, he does have limitation for drugs and prescription and nonprescription for use outside of a covered facility. So he doesn't have it for a pharmacy, he has it if he gets it in.
[CUSTOMER][NEUTRAL] Hello.
[CUSTOMER][NEUTRAL] Yeah.
[AGENT][NEUTRAL] A covered outpatient facility or a covered inpatient facility if he's inpatient or if he's outpatient at an urgent care center MRI imaging center or an ambulatory center.
[AGENT][NEUTRAL] But not for a pharmacy.
[CUSTOMER][NEUTRAL] OK, 1 2nd.
[CUSTOMER][NEUTRAL] So just to repeat to make sure I understood correctly, right? He has prescription coverage so long as it's coming from uh inpatient or outpatient center, but it does not cover for pharmacy benefits.
[AGENT][NEUTRAL] Right.
[AGENT][NEUTRAL] Right, so like if he was in the hospital and they give him prescription drugs there, it would help with deductible, co-pay or co-insurance or if he was in an ER urgent care center, MRI imaging center, or an ambulatory center, and they had to give him a prescription there, it would help cover for what they gave him in one of those centers for deductible co-pay or co-insurance, but it does not have pharmacy benefits.
[CUSTOMER][NEUTRAL] No pharmacy benefit. OK.
[CUSTOMER][POSITIVE] Uh, all right, I understand. Thank you.
[AGENT][POSITIVE] You're welcome. Is there anything else I can help you with before we go?
[CUSTOMER][POSITIVE] No, that's everything thank you.
[AGENT][POSITIVE] You're welcome you guys have a great night and thank you for calling APL.
[CUSTOMER][NEUTRAL] night
[CUSTOMER][NEUTRAL] You too bye bye.
[AGENT][NEUTRAL] Bye-bye.