AccountId: 011433970860
ContactId: 608d7837-82b9-4e57-b697-d002b441391c
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 205029 ms
Total Talk Time (AGENT): 95086 ms
Total Talk Time (CUSTOMER): 68821 ms
Interruptions: 0
Overall Sentiment: AGENT=0.3, CUSTOMER=1.1
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/05/23/608d7837-82b9-4e57-b697-d002b441391c_20250523T12:55_UTC.wav
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[AGENT][NEUTRAL] Thank you for calling API. This is [PII]. How can I help you?
[CUSTOMER][NEUTRAL] Yes, hi, good morning, calling to verify the member's active with the insurance.
[AGENT][NEUTRAL] Um, yes, ma'am. I can assist you with eligibility. Um, first, could I get your name and a good callback number?
[CUSTOMER][NEUTRAL] Yes, [PII]
[CUSTOMER][NEUTRAL] Direct line [PII].
[AGENT][NEUTRAL] OK. Thank you, [PII]. Now, could I get the policy number, please?
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Yes, uh, policy number.
[CUSTOMER][NEUTRAL] 016172.
[CUSTOMER][NEUTRAL] 84
[CUSTOMER][NEUTRAL] Letters ML 7.
[AGENT][NEUTRAL] Please verify the patient's name and date of birth.
[CUSTOMER][NEUTRAL] [PII] last name [PII] [PII].
[AGENT][NEUTRAL] OK, thank you and just let me advise you that verification of coverage does not guarantee payment of claims. Um, she does have a new policy number.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] So new policy number.
[AGENT][NEUTRAL] Um
[AGENT][NEUTRAL] Yes, ma'am. And her new, OK, the new number is 021.
[CUSTOMER][NEUTRAL] Go ahead please.
[AGENT][NEUTRAL] 07
[AGENT][NEUTRAL] 225.
[CUSTOMER][NEUTRAL] OK
[CUSTOMER][NEUTRAL] No, um, letters.
[AGENT][NEUTRAL] Um, no letters, no, ma'am.
[CUSTOMER][NEUTRAL] No letters. OK, perfect. OK, and what was the start date on it?
[AGENT][NEUTRAL] Um, the effective date on this policy was [PII], and the policy is still active.
[CUSTOMER][NEUTRAL] OK, so active.
[CUSTOMER][NEUTRAL] And this is secondary to Medicare, correct?
[AGENT][NEUTRAL] Um, well, not to Medicare. Um, it's secondary to private insurance, medical insurance.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Got you secondary insurance is authorization required?
[AGENT][NEUTRAL] Um, no, there's no authorization required since we are secondary, we go by the primary carrier's guidelines.
[CUSTOMER][NEUTRAL] No.
[CUSTOMER][NEUTRAL] OK, no other car and does the member have inpatient hospital benefits?
[AGENT][NEUTRAL] Um, yes, for inpatient, we cover up to 2500 per calendar year and that's for the co-pay, the co-insurance, and the deductible after the primary insurance processes the claim.
[CUSTOMER][POSITIVE] Got you.
[CUSTOMER][NEUTRAL] OK and then what about for outpatient?
[CUSTOMER][NEUTRAL] Does she have benefits for outpatient?
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] Um, yes, ma'am. For outpatient hospital services, we cover up to 2000 per calendar year for the co-pay, the co-insurance, and the deductible.
[CUSTOMER][NEUTRAL] Um
[CUSTOMER][POSITIVE] Got you perfect can you spell your first name please?
[AGENT][NEUTRAL] Um, it's [PII]. It's spelled [PII] My last initial is [PII].
[CUSTOMER][POSITIVE] Perfect and then reference number for the call please.
[AGENT][NEUTRAL] It will be my name and today's date. Um, is there anything else I can assist you with?
[CUSTOMER][POSITIVE] No that was it. Happy Friday thank you.
[AGENT][POSITIVE] OK, thank you, [PII] for calling APL. Happy Friday to you too. Mm bye.
[CUSTOMER][NEUTRAL] Bye bye.