AccountId: 011433970860
ContactId: 633f36e4-2ad6-41e3-9cbb-440b3efd06a0
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 346549 ms
Total Talk Time (AGENT): 133478 ms
Total Talk Time (CUSTOMER): 152833 ms
Interruptions: 0
Overall Sentiment: AGENT=1, CUSTOMER=0.8
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/02/20/633f36e4-2ad6-41e3-9cbb-440b3efd06a0_20250220T13:46_UTC.wav
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[AGENT][POSITIVE] Good morning. Thank you for calling APL. My name is [PII]. How may I help you?
[CUSTOMER][NEUTRAL] Good morning, [PII]. My name is [PII]. I'm with Derm Care Practitioners and we've had a patient come to us and I'm wondering if she has uh coverage for dermatology. Is there any way we could look at this?
[AGENT][POSITIVE] Yes, I'll be more than happy to help you with the benefits. And [PII], may I have a good contact number in case we're disconnected and then the policy number?
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] [PII].
[CUSTOMER][NEUTRAL] D as in dog, [PII].
[AGENT][NEUTRAL] OK, now, do you have a copy of the member's ID card there with you?
[CUSTOMER][NEUTRAL] Uh, that's what I got it from. It says though it's like a 3 part card and it says member and it says creative circle. Now that's where I've got the group number, the employee ID, and the employee name and then it says medical coverage employee and spouse. There's a pharmacy card and then there's a medical that says multiplan, but when I called that number.
[CUSTOMER][NEUTRAL] Uh, they didn't say anything about benefits. They said to call the other number and that's the on this that would be the number I'm calling for you.
[AGENT][NEUTRAL] OK, did you call [PII] or [PII]?
[CUSTOMER][NEUTRAL] Uh, just dialed [PII].
[AGENT][NEUTRAL] Yeah, OK, um, so the the number that you gave us for 90 Degree benefits, that's a different company. Do you have the member's social? I can check and see if there's a policy here with the social.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Let's see, I don't think I would have his because it's his wife that came to see us, but let me take a quick look here. No, I don't even have.
[AGENT][NEUTRAL] Or what's his first and last name?
[CUSTOMER][NEUTRAL] [PII]
[AGENT][NEUTRAL] OK, hold on one moment.
[CUSTOMER][POSITIVE] Thank you.
[AGENT][POSITIVE] You're welcome.
[AGENT][NEUTRAL] OK. I believe I just located them and this is for dermatology, so hospital.
[AGENT][NEUTRAL] OK. Um, let me see. I just found the policy. I'm waiting for it to come up now.
[CUSTOMER][POSITIVE] OK, thank you so much.
[AGENT][POSITIVE] You're welcome.
[AGENT][NEUTRAL] And can you verify his wife's first and last name and date of birth?
[CUSTOMER][NEUTRAL] Uh, her name is [PII], and that would be [PII].
[AGENT][NEUTRAL] Thank you for that and all the information provided is a verification of benefits, not a guarantee of payment. So the policy number is 246.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] 6099.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] And the policy has been active since [PII].
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] Um, so let me see.
[AGENT][NEUTRAL] For the dermatology coverage. Hold on one moment.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] So, on the policy, the outpatient sickness rider um would pay up to $75 per visit um with a max of 5 visits per calendar year.
[CUSTOMER][NEUTRAL] OK, is it her calendar year.
[CUSTOMER][NEUTRAL] Alright, now, um, where would I go to get claim status because to see if our claim was received.
[AGENT][NEUTRAL] What's the data survey?
[CUSTOMER][NEUTRAL] I was trying to see what.
[CUSTOMER][NEUTRAL] Uh, [PII], and it's a billed amount of $95.
[AGENT][NEUTRAL] OK, hold on one moment.
[AGENT][NEUTRAL] And again, just for the call, all the information provided is a verification of benefits, not a guarantee of payment. Hold on one moment, you said $95.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Yes ma'am.
[CUSTOMER][NEUTRAL] Uh-huh.
[AGENT][NEUTRAL] And what's the name of the facility on the claim?
[CUSTOMER][NEUTRAL] Derm Care Practitioners LLC.
[AGENT][NEUTRAL] Alright, so we received the claim on [PII].
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] And that claim number is 3,561,280.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] And on [PII], we paid to the provider $92.80.
[CUSTOMER][NEUTRAL] 9280 was that by a check?
[AGENT][NEUTRAL] Yes, um, let me get that check number.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] So it's a single check, um, check number 20275887.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][POSITIVE] Oh, [PII], you're so sweet. Is there a reference number for our call?
[AGENT][NEUTRAL] Um, so there's no call reference number, but you can use my name in today's date. The first initial to my last name is [PII].
[CUSTOMER][POSITIVE] Got it well you have a lovely day. You've done a wonderful job.
[AGENT][POSITIVE] Thank you, [PII]. You also thanks for calling APO. Have a great day.
[CUSTOMER][NEUTRAL] Mhm
[CUSTOMER][NEUTRAL] You too. Bye-bye.
[AGENT][NEUTRAL] Bye-bye.