AccountId: 011433970860
ContactId: 5a351491-3f35-462b-818c-5be0be388893
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 255300 ms
Total Talk Time (AGENT): 112460 ms
Total Talk Time (CUSTOMER): 102504 ms
Interruptions: 2
Overall Sentiment: AGENT=0.4, CUSTOMER=2
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/02/05/5a351491-3f35-462b-818c-5be0be388893_20250205T16:32_UTC.wav
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[AGENT][NEUTRAL] Thank you for calling APL. This is [PII]. How can I help you?
[CUSTOMER][NEUTRAL] Hi [PII], my name is [PII]. um, I'm calling in regard I'm calling to get the the eligibility for a member's plan. It's secondary to United Healthcare, so I'm just calling to see if it picks anything up for their for their medical for a specialist office visit.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] Yeah, let's take a look, [PII]. What's the policy number?
[CUSTOMER][NEUTRAL] Um, it is.
[CUSTOMER][NEUTRAL] Is it it's the payer ID I have payer ID 60801 and then.
[CUSTOMER][NEUTRAL] Um, I have another number 16,690.
[CUSTOMER][NEUTRAL] So I'm not sure which one of those it would be.
[AGENT][NEUTRAL] Do you
[AGENT][NEUTRAL] Hm. Do you have any sort of in-hospital or outpatient cert number? Do you have the card or anything like that?
[CUSTOMER][NEUTRAL] No, the patient called and that's the only thing that they gave us.
[AGENT][NEUTRAL] OK, sounds like that's the group number and then our payer ID. Give me just a second, yeah, um.
[CUSTOMER][NEUTRAL] That's what I thought, OK.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] Alright, what is the patient's first and last name?
[CUSTOMER][NEUTRAL] First name is [PII], last name is [PII], [PII]
[AGENT][NEUTRAL] OK
[AGENT][NEUTRAL] All right, thank you for that. And then what is [PII]'s date of birth, please?
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] Alright, so member does have an active plan. The effective date is [PII]. Do you need the policy number?
[CUSTOMER][POSITIVE] That would be awesome.
[AGENT][NEUTRAL] Absolutely. So that's gonna be 0126.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] 247 5.
[CUSTOMER][POSITIVE] Perfect thank you.
[AGENT][NEUTRAL] Yeah, no problem. Let me see, some of these plans will cover the office visit fee, some of them don't, so let me just double check here.
[CUSTOMER][NEUTRAL] OK, OK.
[AGENT][NEUTRAL] All right. So it looks like
[AGENT][NEUTRAL] Uh, the policy itself does not cover the office visit fee. It does cover any sort of like treatment or services in office. It does have an outpatient benefit max calendar day, which is $500.
[CUSTOMER][NEUTRAL] Mm
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][POSITIVE] Perfect, so if we do any testing, it would, it would be covered, correct?
[AGENT][NEUTRAL] Mhm.
[AGENT][NEUTRAL] Yes, ma'am. Yeah.
[CUSTOMER][POSITIVE] Perfect. Now my question is if let's say the testing falls under the office visit.
[CUSTOMER][NEUTRAL] Would it be would it be picked up by APL?
[AGENT][NEUTRAL] Yeah, the fees, any sort of fees that their primary doesn't cover for any sort of testing, then we would pick up. The only thing we would not pick up is the co-pay for the office visit.
[CUSTOMER][NEUTRAL] OK, because I mean the test would probably fall under that office visit copay, so I'm not sure if it would.
[CUSTOMER][NEUTRAL] We'll probably just bill the patient, you know what I mean? Yeah, because sometimes if it's billed with it, it's, it's, you know, it's under that co-pay and then if it's not then it's completely separate. OK perfect.
[AGENT][NEUTRAL] I get what you're saying, yeah.
[AGENT][NEUTRAL] Yeah.
[AGENT][POSITIVE] I got you.
[CUSTOMER][POSITIVE] Alright [PII], and if I could just have the first initial to your last name and a reference number for the call, that would be great.
[AGENT][NEUTRAL] Yeah, absolutely call reference is actually my name with my last initial and then today's date. The last initial to my name is [PII].
[CUSTOMER][POSITIVE] Perfect. All right, [PII], thank you so much for your time. I do appreciate it.
[AGENT][POSITIVE] You're welcome. Have a good one day.
[CUSTOMER][POSITIVE] Thank you you too bye bye.
[AGENT][NEUTRAL] Bye bye.