AccountId: 011433970860
ContactId: 5dea650c-06b5-48b6-a1bf-d00ac4bed9c3
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 400959 ms
Total Talk Time (AGENT): 113692 ms
Total Talk Time (CUSTOMER): 185079 ms
Interruptions: 1
Overall Sentiment: AGENT=0.6, CUSTOMER=0.2
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/01/31/5dea650c-06b5-48b6-a1bf-d00ac4bed9c3_20250131T13:24_UTC.wav
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[AGENT][NEUTRAL] Calling APL. This is [PII]. How may I help you?
[CUSTOMER][NEUTRAL] Hi, this is [PII] calling on behalf of the test fire together program on a recorded line for training and quality assurance. I'm looking for some benefit information for the patient.
[AGENT][NEUTRAL] OK, I can help you. Can you spell your first name?
[CUSTOMER][NEUTRAL] Uh sure. My first name is [PII], spelled as [PII] and the initial to my last name is [PII].
[AGENT][NEUTRAL] OK. And you're looking for eligibility and benefits. Is this in a doctor's office?
[CUSTOMER][NEUTRAL] It is a specialist office and I'm calling to verify in-network benefits for an injection of test fire with the procedure code G2356 administered in a specialist office. And the CPT code is sure.
[AGENT][NEUTRAL] OK, and the
[AGENT][NEUTRAL] Policy number?
[CUSTOMER][NEUTRAL] Let me get that quickly for you.
[CUSTOMER][NEUTRAL] It is 017.
[CUSTOMER][NEUTRAL] 92121.
[AGENT][NEUTRAL] And what's a good phone number in case we're disconnected?
[CUSTOMER][NEUTRAL] It is [PII].
[AGENT][NEUTRAL] One moment.
[CUSTOMER][NEUTRAL] No extension required.
[AGENT][NEUTRAL] Uh-huh.
[AGENT][NEUTRAL] And what is the patient's name and date of birth?
[CUSTOMER][NEUTRAL] Sure, uh, patient's first name. It is [PII], and uh
[CUSTOMER][NEUTRAL] Last name is [PII], that is [PII]
[CUSTOMER][NEUTRAL] SIP and uh the date of birth, it is [PII].
[AGENT][NEUTRAL] Thank you for that information, uh, [PII], the policy effective date is [PII]. So the policy is active at this time. And let me pull up the benefits for uh the treatment in the office.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Sure. Uh let me quickly share that the quote again.
[AGENT][NEUTRAL] So the maxim
[AGENT][NEUTRAL] I do not need the codes.
[AGENT][NEUTRAL] So the max, so the outpatient and inpatient benefit is combined for a maximum of up to $5000.
[CUSTOMER][NEUTRAL] OK, sure. You can go ahead.
[CUSTOMER][NEUTRAL] Yeah
[CUSTOMER][NEUTRAL] All right.
[AGENT][NEUTRAL] That is per calendar year.
[CUSTOMER][NEUTRAL] And
[AGENT][NEUTRAL] The information provided is verification, not a guarantee of payment.
[CUSTOMER][NEUTRAL] Yeah
[CUSTOMER][NEUTRAL] Yeah
[CUSTOMER][NEUTRAL] Yeah.
[AGENT][NEUTRAL] And I'll check to see if any of that benefit has been used.
[CUSTOMER][NEUTRAL] Sure.
[CUSTOMER][NEUTRAL] provided.
[AGENT][NEUTRAL] Do not show any of that benefit has been used for [PII]. And any other questions I could assist with today, [PII]?
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Uh, sure, let me just quickly, uh, do that. And the security code is [PII] and the diagnosis code is 045.551. But first, could you please spell out your first name and the initial of your last?
[AGENT][NEUTRAL] You'll use my name and today's status reference for today's call. [PII], first initial last name is [PII].
[CUSTOMER][NEUTRAL] Uh
[CUSTOMER][NEUTRAL] Mm
[CUSTOMER][NEUTRAL] Uh, can you please repeat the name again? I do apologize.
[AGENT][NEUTRAL] [PII],
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] [PII].
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Um
[CUSTOMER][NEUTRAL] OK. And the initial it is [PII], correct?
[AGENT][NEUTRAL] [PII].
[CUSTOMER][NEUTRAL] [PII]. OK. And first, I have some general plan questions. Can we please proceed with those first?
[AGENT][NEUTRAL] Go ahead.
[CUSTOMER][NEUTRAL] OK. So, uh, what is the plan name?
[AGENT][NEUTRAL] OK, the type of plan is a Metlink policy.
[CUSTOMER][NEUTRAL] Main policy, M E T L I N K policy.
[AGENT][POSITIVE] Correct.
[AGENT][NEUTRAL] M E D as in David, L I N K.
[CUSTOMER][NEUTRAL] Uh
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Mying policy.
[CUSTOMER][NEUTRAL] And since you have already shared with the policy effective date, that is [PII] and it is still effective.
[CUSTOMER][NEUTRAL] And what type of plan is this? Is it a PPO, POS, or HMO plan?
[AGENT][NEUTRAL] It's not, neither, it's a meddling policy, secondary to the major medical plan.
[CUSTOMER][NEUTRAL] Yeah
[CUSTOMER][NEUTRAL] Mhm
[CUSTOMER][NEUTRAL] OK, let me quickly put that up.
[CUSTOMER][NEUTRAL] Just bear with me for a few seconds.
[CUSTOMER][POSITIVE] And thank you so much for your patience. And is this a commercial or Medicare Advantage plan?
[AGENT][NEUTRAL] This policy is secondary to the major medical policy.
[CUSTOMER][NEUTRAL] I mean, is this a government-funded plan such as Medicaid or Medicare?
[AGENT][NEUTRAL] OK, I'm saying no. It's a Medlink policy, secondary to the major medical insurance plan.
[CUSTOMER][NEUTRAL] Um
[AGENT][NEUTRAL] Any other questions?
[CUSTOMER][NEUTRAL] And just to confirm, is it a Medicare supplemental plan?
[CUSTOMER][NEUTRAL] OK
[AGENT][NEUTRAL] OK, [PII], I'm not sure why we're not understanding each other. Can I speak with your supervisor?
[CUSTOMER][NEUTRAL] I
[CUSTOMER][NEUTRAL] Uh, you can help me with that, and he's not available at the moment. I do apologize for that.
[AGENT][NEUTRAL] OK, so I've indicated that the policy type is a meddling policy.
[CUSTOMER][NEUTRAL] It
[CUSTOMER][NEUTRAL] OK, uh, yes, sir, you mentioned again the, the call reference number. It is your name and today's date, correct?
[AGENT][POSITIVE] Correct.
[CUSTOMER][POSITIVE] OK. And thank you so much for your help today. Bye-bye.
[AGENT][POSITIVE] You're welcome thanks for calling [PII] have a good day.