AccountId: 011433970860
ContactId: 5c483a36-8d84-4d75-8641-e8d58f3d395a
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 523070 ms
Total Talk Time (AGENT): 209987 ms
Total Talk Time (CUSTOMER): 166506 ms
Interruptions: 2
Overall Sentiment: AGENT=0.1, CUSTOMER=0.2
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/01/07/5c483a36-8d84-4d75-8641-e8d58f3d395a_20250107T20:56_UTC.wav
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[AGENT][POSITIVE] Thanks for calling APL. This is [PII]. How may I assist you?
[CUSTOMER][NEUTRAL] Uh, yeah, I was calling to see if a patients got there's a couple of, um, codes I was trying to see is covered on patients plan.
[AGENT][NEUTRAL] Can I have a name, your name and a callback number.
[CUSTOMER][NEUTRAL] [PII], it's [PII].
[AGENT][NEUTRAL] [PII], what is the policy number of the member that you're inquiring eligibility for, and I'll be able to assist you.
[CUSTOMER][NEUTRAL] MCMAB 1012076
[AGENT][NEUTRAL] That's not a policy number here at American Public Life. Are you sure it says American Public Life on the card?
[CUSTOMER][POSITIVE] Yeah, I just talked to someone and got benefits on them.
[AGENT][NEUTRAL] That's not their policy number here at American Public Life. Our policy starts with letters, numbers and not letters.
[AGENT][NEUTRAL] Did they give you a policy number?
[CUSTOMER][NEUTRAL] OK, try
[CUSTOMER][NEUTRAL] Uh uh.
[AGENT][NEUTRAL] So do you have the member's social because that's not a policy number here.
[CUSTOMER][NEUTRAL] No, I don't have a social.
[CUSTOMER][NEUTRAL] I just got done talking to someone and they uh.
[CUSTOMER][NEUTRAL] Maybe the max and deductible, the coverage.
[AGENT][NEUTRAL] So how they didn't give you the policy number, the correct policy number?
[CUSTOMER][NEUTRAL] No, that's what I gave him, but she didn't say anything that it wasn't wrong or anything.
[AGENT][NEUTRAL] Mm, that's not a policy number here. What is the member's last name?
[CUSTOMER][NEUTRAL] [PII]
[AGENT][NEUTRAL] First name?
[CUSTOMER][NEUTRAL] [PII]
[AGENT][NEUTRAL] What city and state does that member live in?
[CUSTOMER][NEUTRAL] Uh, uh, I don't know what city, but it's.
[CUSTOMER][NEUTRAL] [PII] maybe [PII].
[AGENT][NEUTRAL] So, that name, [PII] is broad. You sure you call here at American Public Life and somebody gave you that information?
[CUSTOMER][NEUTRAL] Yes.
[AGENT][NEUTRAL] Cause her, this is a broad name. That's why I'm trying to see. You had to give them something else for them to verify her.
[CUSTOMER][NEUTRAL] No, I did not. I just, uh.
[CUSTOMER][NEUTRAL] Gave him the name and birthday and the ID number.
[AGENT][NEUTRAL] What is your date of birth?
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] Mm, it's not her.
[AGENT][NEUTRAL] Do you know who you spoke with? Did somebody give you their name?
[CUSTOMER][NEUTRAL] I don't remember the name. No, I didn't get her name. I'm sorry, um, she was gonna send me, she's gonna send me.
[AGENT][NEUTRAL] I'm not able to find [PII]. She has a lot of.
[AGENT][NEUTRAL] A lot of animals in the system.
[CUSTOMER][NEUTRAL] Yeah, they
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Maybe could you try taking the letters out and just do the numbers that are in the.
[AGENT][NEUTRAL] So give me the numbers.
[CUSTOMER][NEUTRAL] In there?
[CUSTOMER][NEUTRAL] 1012076
[AGENT][NEUTRAL] Mhm.
[AGENT][NEUTRAL] Do you have a copy of the card?
[CUSTOMER][NEUTRAL] I don't we haven't seen her yet.
[AGENT][NEGATIVE] She didn't give you her social or anything cause that's not, I don't.
[CUSTOMER][NEUTRAL] No, we haven't, we haven't seen the patient yet um we just get their name, birthday, and their insurance ID number.
[AGENT][NEUTRAL] Mm.
[CUSTOMER][NEUTRAL] We try to verify their insurance before they come.
[AGENT][NEUTRAL] Right, which is understandable. However, I don't, it's not much that I can go by because the policy number that you provided is not the correct policy number and then the last name and the first name is [PII]. There's multiple [PII] in the system.
[CUSTOMER][NEUTRAL] Yeah
[CUSTOMER][NEUTRAL] With the same birthday?
[AGENT][NEUTRAL] We can't see the date of birth without clicking on all the names. I'm not gonna click on every single [PII] to verify date of birth, when it's a bulk of them.
[CUSTOMER][NEUTRAL] Uh,
[CUSTOMER][NEUTRAL] Mm, right.
[CUSTOMER][NEUTRAL] Yeah, that's crazy.
[AGENT][NEUTRAL] And that's why if you did speak to someone, I wish they had gave you the the correct policy number because that's what I do when somebody don't have the correct policy number just in case they have to call again, you don't have to pay play where as Waldo when you're looking for the patient.
[CUSTOMER][NEUTRAL] I don't know how they did it.
[CUSTOMER][NEUTRAL] Right.
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] Well, if you can hang on one second, I can call their, their dentist that referred them and see if they have a different ID.
[AGENT][NEUTRAL] And
[AGENT][POSITIVE] Sure, or social, that'll be grateful, very helpful.
[CUSTOMER][NEUTRAL] OK, OK, let me, let me, let me call him real quick hang on.
[AGENT][NEUTRAL] Mhm.
[AGENT][NEUTRAL] So
[CUSTOMER][NEUTRAL] OK, they didn't have her social but they have an ID number of [PII].
[AGENT][NEUTRAL] And what is this member's name?
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] Date of birth?
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] OK, so that's the correct policy number.
[CUSTOMER][NEUTRAL] OK
[AGENT][NEUTRAL] Would you like for me to send you a fax back of those benefits?
[CUSTOMER][NEUTRAL] I bet the patient called and gave the ID.
[CUSTOMER][NEUTRAL] Yeah, yeah, that's fine.
[CUSTOMER][NEUTRAL] She's getting a she's having a retreat done and I don't have that as a coverage thing on your list so I just wanted to check that.
[AGENT][NEUTRAL] Uh
[CUSTOMER][NEUTRAL] But yeah you can send me that too just so I can have it downloaded in her in her chart.
[AGENT][NEUTRAL] And I pull up the policy. Her actual benefit schedule itself.
[CUSTOMER][NEUTRAL] But
[AGENT][NEUTRAL] And what is that, do you have that procedure code?
[CUSTOMER][NEUTRAL] Yeah it's 334 8.
[AGENT][NEUTRAL] 334 8 7348.
[CUSTOMER][NEUTRAL] Like in [PII] she got the dog.
[CUSTOMER][NEUTRAL] And like I think you and I.
[AGENT][NEUTRAL] Mm, what is your, when you say, what is the description of the 3348?
[CUSTOMER][NEUTRAL] Yeah
[CUSTOMER][NEUTRAL] Um, bowler retreat.
[AGENT][NEGATIVE] Maer retreat.
[AGENT][NEUTRAL] Is there like a root canal or or crown?
[CUSTOMER][NEUTRAL] Yeah, it's a, yeah.
[CUSTOMER][NEUTRAL] It's redo a root canal.
[AGENT][NEUTRAL] Oh.
[CUSTOMER][NEUTRAL] I feel like I DoorDash.
[AGENT][NEUTRAL] So I have 32 2033 1033 2033 30, and 3352, and 3353, but I don't have a.
[CUSTOMER][NEUTRAL] OK, not so it's just not covered.
[AGENT][NEUTRAL] 3348.
[CUSTOMER][NEUTRAL] Yeah
[AGENT][NEUTRAL] But see our codes haven't been updated so I don't know if that's the new code or that's the older code.
[CUSTOMER][NEUTRAL] Oh.
[AGENT][NEUTRAL] I'm trying to look at the description like, is this the actual retreat for, is that like a replacement or is it just gonna say retreat because.
[CUSTOMER][NEUTRAL] It's just gonna say retreat.
[AGENT][NEUTRAL] Cause I do see repair.
[CUSTOMER][NEUTRAL] But
[AGENT][NEUTRAL] Oh.
[AGENT][NEUTRAL] Yeah, I don't see this code is not listed, but I do see something that will repair. OK, so it's not covered, but I could send you a schedule so you could verify what is covered under the policy.
[CUSTOMER][NEUTRAL] I don't think it's a covered charge.
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][POSITIVE] Yeah sounds good.
[AGENT][NEUTRAL] What's your fax number?
[CUSTOMER][NEUTRAL] [PII].
[CUSTOMER][NEUTRAL] [PII].
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] And what was your name?
[CUSTOMER][NEUTRAL] [PII]
[AGENT][NEUTRAL] Right
[CUSTOMER][NEUTRAL] Uh-huh.
[AGENT][NEUTRAL] Alright, thank you [PII]. So I got [PII].
[CUSTOMER][NEUTRAL] Uh huh.
[CUSTOMER][NEUTRAL] Yes.
[AGENT][NEUTRAL] Is there anything else that I can assist you with today?
[CUSTOMER][NEUTRAL] That's it.
[AGENT][POSITIVE] Alright, faithful. I'm gonna send this over for you. Thanks for calling APL. Have a great day.
[CUSTOMER][POSITIVE] Thank you.
[CUSTOMER][NEUTRAL] Alright
[CUSTOMER][NEUTRAL] Alright bye bye.