AccountId: 011433970860
ContactId: 5e4ac9ce-8820-4390-b4cc-7fed5ce178cd
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 252169 ms
Total Talk Time (AGENT): 124032 ms
Total Talk Time (CUSTOMER): 78252 ms
Interruptions: 0
Overall Sentiment: AGENT=1.9, CUSTOMER=1
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/01/16/5e4ac9ce-8820-4390-b4cc-7fed5ce178cd_20250116T13:58_UTC.wav
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[AGENT][POSITIVE] Good morning. Thank you for calling APL. This is [PII]. How can I help you?
[CUSTOMER][NEUTRAL] Hi, good morning. My name is [PII] calling from Center for Diagnostic Imaging. Um, I'm calling regarding a patient for eligibility.
[AGENT][NEUTRAL] OK, and you said your name is [PII], is that correct? OK, and you're just needing eligibility, not benefit information, is that correct?
[CUSTOMER][POSITIVE] Correct, yes.
[CUSTOMER][NEUTRAL] Yes.
[AGENT][NEUTRAL] Yes, ma'am, I can help you. And what is your callback number please, [PII]?
[CUSTOMER][NEUTRAL] Yeah and I.
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] Thank you. And what is the member's policy number?
[CUSTOMER][NEUTRAL] It is.
[CUSTOMER][POSITIVE] Oh wow.
[CUSTOMER][NEUTRAL] I think that I think it's a little old so I can't really see the letters. I can see the first one.
[CUSTOMER][NEUTRAL] 01070
[CUSTOMER][NEUTRAL] 842.
[AGENT][POSITIVE] OK, thank you, give me one moment please.
[CUSTOMER][POSITIVE] No problem.
[AGENT][POSITIVE] Thank you.
[CUSTOMER][NEUTRAL] Oh.
[CUSTOMER][NEUTRAL] Oh
[CUSTOMER][NEUTRAL] And
[AGENT][NEUTRAL] OK, and [PII], any information provided would be a verification of benefits and not a guarantee of payment. What is your patient's name and their date of birth?
[CUSTOMER][NEUTRAL] His name is [PII].
[CUSTOMER][NEUTRAL] Date of birth [PII].
[AGENT][POSITIVE] OK, thank you. So I do appreciate that he is the subscriber on the supplemental policy, and this policy is active with an effective date of [PII].
[CUSTOMER][NEUTRAL] Uh-huh.
[CUSTOMER][NEUTRAL] Yeah
[AGENT][NEUTRAL] [PII].
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] And then on this policy, because it is a supplemental to his primary insurance, [PII], when the claim is submitted to APL for review, we must also have a copy of his primary insurance company's explanation of benefits as well.
[CUSTOMER][NEUTRAL] Yeah.
[AGENT][NEUTRAL] And then we do have a portal for you all to be able to check claim status and have access to our EOBs.
[AGENT][NEUTRAL] And our portal website is at secured.
[AGENT][NEUTRAL] [PII].
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][POSITIVE] Perfect. If I wanted to know if one of his exams is covered, I will have to speak to someone else, or I can ask you.
[AGENT][NEUTRAL] I can provide benefit information if you're needing benefit information. I'm sorry, I didn't think that you needed that.
[CUSTOMER][NEUTRAL] Uh-huh.
[CUSTOMER][NEUTRAL] No, yeah, um, so he's here for a CT scan.
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] And with his primary, um, United Healthcare, he does have a deductible, so I want to see if this insurance covers that.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] OK, so this plan is designed to help with co-pays, deductibles and co-insurance amounts of coverage services. He has an outpatient benefit.
[CUSTOMER][NEUTRAL] [PII]
[AGENT][NEUTRAL] Per occurrence.
[CUSTOMER][NEUTRAL] Oh.
[AGENT][NEUTRAL] Of $500 with no outpatient deductible.
[CUSTOMER][NEUTRAL] Yeah
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Perfect, um, can I please have a reference number for this call?
[AGENT][NEUTRAL] Mhm.
[AGENT][POSITIVE] Yes, ma'am, you will actually use my name.
[AGENT][NEUTRAL] Along with today's date, [PII].
[CUSTOMER][NEUTRAL] What is it again?
[CUSTOMER][NEUTRAL] What's your name again?
[AGENT][NEUTRAL] [PII].
[CUSTOMER][NEUTRAL] [PII]? Oh [PII].
[AGENT][NEUTRAL] [PII]
[CUSTOMER][POSITIVE] Oh perfect [PII] and today's date.
[AGENT][POSITIVE] Mhm, that is correct.
[CUSTOMER][POSITIVE] Perfect thank you so much.
[AGENT][POSITIVE] You're welcome. And is there anything else that I can help you with?
[CUSTOMER][NEUTRAL] That'll be it.
[AGENT][POSITIVE] OK, well then if that's all I can help you with, thank you again for calling APL Michelle. I hope you have a great day.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Hm
[CUSTOMER][POSITIVE] Thank you you too bye.
[AGENT][NEUTRAL] Bye bye.