AccountId: 011433970860
ContactId: 59e4cd08-da36-4293-83ee-03adb73cdfe5
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 277179 ms
Total Talk Time (AGENT): 119134 ms
Total Talk Time (CUSTOMER): 107048 ms
Interruptions: 0
Overall Sentiment: AGENT=1, CUSTOMER=0.8
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/06/17/59e4cd08-da36-4293-83ee-03adb73cdfe5_20250617T13:42_UTC.wav
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[AGENT][POSITIVE] Good morning. Thank you for calling APL. My name is [PII]. How may I help you?
[CUSTOMER][NEUTRAL] Hi, this is [PII] calling from the provider's office for checking on an eligibility and benefit status for the patient.
[AGENT][POSITIVE] OK, well, I can help you with both the eligibility and benefits, [PII], and how are you doing today?
[CUSTOMER][POSITIVE] Uh, I'm good. Thanks for asking. And how about your day?
[AGENT][POSITIVE] I'm doing well, thanks for asking. And may I have a good contact number in case we're disconnected and the policy number?
[CUSTOMER][NEUTRAL] [PII]. It's a direct line. And the policy ID is 02611804.
[AGENT][NEUTRAL] OK, hold on one moment.
[CUSTOMER][NEUTRAL] Sure.
[AGENT][NEUTRAL] All right, and I have the member here. Can you verify the member's first and last name and date of birth?
[CUSTOMER][NEUTRAL] First name is [PII]. Last name is uh [PII], [PII] is the date of birth.
[AGENT][NEUTRAL] Thank you for that and all the information provided is a verification of benefits, not a guarantee of payment. So I am showing the policy is active. It's been effective since [PII].
[CUSTOMER][NEUTRAL] Uh-huh.
[CUSTOMER][NEUTRAL] OK. Still active, ma'am?
[AGENT][NEUTRAL] Yes, it's still active.
[CUSTOMER][NEUTRAL] Uh, can you also please help me with the group number for this patient?
[AGENT][NEUTRAL] Sure, the group number is 270.
[AGENT][NEUTRAL] 35.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Oh, and a plan, ma'am. Uh, is this a PPO plan, HMO or?
[AGENT][NEUTRAL] This is
[AGENT][NEUTRAL] Um, so this is the secondary insurance. It's a medlink policy, so there's no network on the secondary.
[CUSTOMER][NEUTRAL] Uh, OK. So this is a Med plan.
[CUSTOMER][NEUTRAL] Or is this a supplemental.
[AGENT][NEUTRAL] Yeah,
[AGENT][NEUTRAL] Yes, it's a Min supplemental gap insurance policy.
[AGENT][NEUTRAL] We are 2nd to Aetna, so Aetna would have the network.
[CUSTOMER][NEUTRAL] 1 2nd.
[CUSTOMER][POSITIVE] Oh, thank you.
[CUSTOMER][NEUTRAL] Uh, can you also please help me with the, uh, claims, mailing address and the payer ID?
[AGENT][NEUTRAL] Yes, our payer ID is 60.
[AGENT][NEUTRAL] 801.
[AGENT][NEUTRAL] And our claims mailing address is [PII].
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] 950.
[CUSTOMER][NEUTRAL] Uh-huh.
[AGENT][NEUTRAL] [PII].
[CUSTOMER][NEUTRAL] Uh-huh.
[AGENT][NEUTRAL] [PII].
[CUSTOMER][NEUTRAL] Uh-huh.
[AGENT][NEUTRAL] Zip code is [PII].
[AGENT][NEUTRAL] [PII].
[CUSTOMER][NEUTRAL] Uh-huh.
[CUSTOMER][POSITIVE] Oh, thank you so much for this information. Now, can you please help me with this patient have any uh deductible amount?
[AGENT][NEUTRAL] Hold on one moment.
[AGENT][NEUTRAL] Are you considered outpatient or inpatient?
[CUSTOMER][NEUTRAL] Uh, one second, please.
[CUSTOMER][NEUTRAL] Mm, I'm sorry, ma'am. I don't have that information.
[AGENT][NEUTRAL] Is the member going to be admitted or is this a, if they're not admitted, it's outpatient?
[CUSTOMER][NEUTRAL] Uh, uh,
[CUSTOMER][NEUTRAL] OK. The, uh, the services already have been done, ma'am. [PII].
[AGENT][NEUTRAL] Right, I'm asking you these questions so I know what to quote you. If you're, if the member was inpatient, that is a set of benefits. I'm just gonna go with outpatient. You're not a hospital, are you? Like a like a
[CUSTOMER][NEUTRAL] OK
[AGENT][NEUTRAL] Hospital.
[CUSTOMER][NEGATIVE] No, no, no, no. No, no.
[AGENT][NEUTRAL] OK, so it will be outpatient. So for outpatient, the max is $6000.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] And there's no deductible.
[CUSTOMER][POSITIVE] Uh, thank you so much for all this information, ma'am. And uh can you also please help me with the uh call reference number for our call?
[AGENT][NEUTRAL] Sure, so there's no call reference number, but you can use my name and today's date. And again, that's [PII], first initial to my last name is [PII].
[CUSTOMER][POSITIVE] Thank you so much, ma'am. Thank you again and have a great day. Bye-bye.
[AGENT][NEUTRAL] You're welcome, [PII]. Was there anything else I can assist you with today?
[CUSTOMER][NEUTRAL] No, ma'am.
[AGENT][POSITIVE] All right, thanks for calling APL. Bye-bye.