AccountId: 011433970860
ContactId: 5ff8ae10-5070-4e7a-98e1-39457bf6e8c1
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 594380 ms
Total Talk Time (AGENT): 166173 ms
Total Talk Time (CUSTOMER): 174043 ms
Interruptions: 0
Overall Sentiment: AGENT=0.7, CUSTOMER=0.1
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/05/15/5ff8ae10-5070-4e7a-98e1-39457bf6e8c1_20250515T18:17_UTC.wav
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[AGENT][POSITIVE] Good afternoon. Thank you for calling APL. My name is [PII]. How may I help you?
[CUSTOMER][NEUTRAL] Hi, [PII]. Good afternoon. This is [PII]. I'm calling from provider office to checking the urgent care eligibility for this patient and my last name first initial is [PII].
[AGENT][POSITIVE] OK, well, I'll be more than happy to assist you with the urgent care eligibility and [PII], may I have a good contact number in case we're disconnected and the policy number?
[CUSTOMER][NEUTRAL] Uh, sure, sure. And your last initial, what, what about your last initial?
[AGENT][NEUTRAL] I'm sorry, it's [PII].
[CUSTOMER][POSITIVE] Thank you so much.
[CUSTOMER][NEUTRAL] Mm OK. You're asking the callback number, right?
[AGENT][NEUTRAL] Yes, callback number and policy number.
[CUSTOMER][NEUTRAL] The callback number is [PII] [PII].
[CUSTOMER][NEUTRAL] The policy number I have that D as in Delta.
[CUSTOMER][NEUTRAL] 4
[CUSTOMER][NEUTRAL] 3 732799.
[AGENT][NEUTRAL] OK, do you have a copy of the member's ID card available?
[CUSTOMER][NEUTRAL] Mm, yes.
[AGENT][NEUTRAL] On the ID card, do you see anywhere that says in hospital or outpatient policy er number?
[CUSTOMER][NEUTRAL] Um.
[AGENT][NEUTRAL] You just start with a 01 or 02?
[CUSTOMER][NEGATIVE] No, no.
[CUSTOMER][NEUTRAL] I didn't see any of that because 0102.
[AGENT][NEUTRAL] May I have the member's first and last name?
[CUSTOMER][NEUTRAL] And, and how?
[CUSTOMER][NEUTRAL] Sure, sure. The number's first name is?
[CUSTOMER][NEUTRAL] So [PII].
[CUSTOMER][NEUTRAL] [PII],
[CUSTOMER][NEUTRAL] [PII].
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] That's the first name?
[CUSTOMER][NEUTRAL] OK. The last thing you want the last name?
[AGENT][NEUTRAL] Yes, I need the last name also, yes, please.
[CUSTOMER][NEUTRAL] [PII].
[CUSTOMER][NEUTRAL] [PII].
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] OK, hold on one moment.
[AGENT][NEUTRAL] So I'm just waiting for the policies to populate. Hold on one moment.
[AGENT][NEUTRAL] And the spelling of the first name is [PII]?
[CUSTOMER][NEUTRAL] Sure.
[CUSTOMER][NEUTRAL] [PII]
[AGENT][NEUTRAL] [PII]. OK, hold on one moment.
[CUSTOMER][NEUTRAL] Sure.
[AGENT][NEUTRAL] OK, here we go. Alright, so the policy is just populated. Hold on one moment while I get the policy number.
[CUSTOMER][NEUTRAL] Sure.
[AGENT][NEUTRAL] And can you verify the date of birth for me, please?
[CUSTOMER][NEUTRAL] The member's uh date of birth is.
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] Thank you for that and all the information provided is a verification of benefits, not a guarantee of payment. I am showing the policy is active. It's been effective since [PII].
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] And hold on one moment, I'm waiting for the benefits to come up. Let me give you the um policy number. It's 25.
[CUSTOMER][NEUTRAL] No, I don't want the benefits detail. Uh, yes, yes. OK, probably with the policy number first.
[AGENT][NEUTRAL] Did you
[AGENT][NEUTRAL] I'm sorry, you asked for urgent care eligibility, correct?
[AGENT][NEUTRAL] Or did you want to know if the policy was active?
[CUSTOMER][NEUTRAL] Yes.
[CUSTOMER][NEUTRAL] Yes sir, I'm on not the eligibility, but I don't want to explaination of uh benefits. Just they have the medical benefits or not, that is enough.
[AGENT][NEUTRAL] Yes, that's what I'm looking for. Um, let me give you the policy number and I'll look for the benefits.
[CUSTOMER][NEUTRAL] Sure, sure.
[AGENT][NEUTRAL] The policy number is 259.
[CUSTOMER][NEUTRAL] 2
[AGENT][NEUTRAL] 49
[CUSTOMER][NEUTRAL] 259
[CUSTOMER][NEUTRAL] 449.
[AGENT][NEUTRAL] 18.
[CUSTOMER][NEUTRAL] Oh
[CUSTOMER][NEUTRAL] 18
[AGENT][NEUTRAL] And the the policy does have
[CUSTOMER][NEUTRAL] That's it?
[AGENT][NEUTRAL] Yes, that's it for the policy number and for the benefits, the policy does have benefits for office.
[AGENT][NEUTRAL] For urgent care.
[AGENT][NEUTRAL] Did you need to know the actual benefit?
[CUSTOMER][NEUTRAL] They don't have medical.
[CUSTOMER][NEUTRAL] It
[AGENT][NEUTRAL] Uh
[CUSTOMER][POSITIVE] The benefits on there.
[AGENT][NEUTRAL] The policy will pay up to $75 per visit with a max of 5 visits per calendar year.
[CUSTOMER][NEUTRAL] Just 1 2nd.
[AGENT][NEUTRAL] Mm
[CUSTOMER][NEUTRAL] It was affected date.
[AGENT][NEUTRAL] Hold on one moment.
[CUSTOMER][NEUTRAL] I
[AGENT][NEUTRAL] The policy became effective on [PII].
[CUSTOMER][NEUTRAL] The plant
[AGENT][NEUTRAL] Hospital indemnity.
[CUSTOMER][NEUTRAL] Sorry?
[AGENT][NEUTRAL] The plan type is hospital.
[CUSTOMER][NEUTRAL] Yeah
[CUSTOMER][NEUTRAL] A.
[AGENT][NEUTRAL] Indemnity.
[CUSTOMER][NEUTRAL] It
[CUSTOMER][NEUTRAL] And you act as a primary or secondary?
[AGENT][NEUTRAL] This is a limited medical policy, um, so they could have other insurance.
[AGENT][NEUTRAL] So I, I don't, for this one, this is the only policy they have with us. It's not a secondary, but they may have other insurance that we don't know about.
[CUSTOMER][NEUTRAL] OK. What about the claims mailing address?
[AGENT][NEUTRAL] Um, [PII].
[CUSTOMER][NEUTRAL] [PII]
[AGENT][NEUTRAL] [PII].
[CUSTOMER][NEUTRAL] Yeah.
[AGENT][NEUTRAL] [PII].
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] The time limit?
[AGENT][NEUTRAL] Um, there's no timely filing as long as the policy is active on the data service, you can file at any time.
[CUSTOMER][NEUTRAL] it
[CUSTOMER][NEUTRAL] OK, there is no time limit, right?
[AGENT][POSITIVE] Correct.
[CUSTOMER][NEUTRAL] I
[CUSTOMER][NEUTRAL] And do you have a fax number?
[AGENT][NEUTRAL] Um, no, there's no fax number. There is a payer ID if you need it.
[CUSTOMER][NEUTRAL] OK. Could you provide the pay ID?
[AGENT][NEUTRAL] It's [PII].
[CUSTOMER][NEUTRAL] OK. And the patient or medical benefits?
[AGENT][NEUTRAL] I'm sorry?
[CUSTOMER][NEUTRAL] The patient of medical benefits or not?
[AGENT][NEUTRAL] Yes, this is a medical policy.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Mm
[CUSTOMER][NEUTRAL] OK. And you provide your member IDP 2594918, right?
[AGENT][POSITIVE] Yes, that's correct.
[CUSTOMER][NEUTRAL] OK. What about the reference number?
[AGENT][NEUTRAL] So there's no call reference number. You can use my name in today's date. The first initial to my last name is [PII].
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][POSITIVE] Thank you so much.
[AGENT][POSITIVE] You're welcome. Was there anything else I can assist you with today?
[CUSTOMER][NEUTRAL] No, that's all about today.
[AGENT][POSITIVE] Alright, thanks for calling APL. Bye-bye.
[CUSTOMER][NEUTRAL] Bye.