AccountId: 011433970860
ContactId: 64a31f82-a331-411f-9d5c-bc3a601d9ce1
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 346049 ms
Total Talk Time (AGENT): 187600 ms
Total Talk Time (CUSTOMER): 119372 ms
Interruptions: 3
Overall Sentiment: AGENT=1, CUSTOMER=1.4
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/05/21/64a31f82-a331-411f-9d5c-bc3a601d9ce1_20250521T14:14_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] Hey, good morning [PII]. My name is [PII]. I'm calling with Oklahoma Heart Hospital. How are you today?
[AGENT][POSITIVE] Yes, ma'am. I'm good, [PII]. How are you today?
[CUSTOMER][NEUTRAL] I'm well thank you very much for asking Miss [PII]. I was calling to check eligibility and benefits, make sure we're a network, and then lastly to see if prior office required for some testing outpatient testing.
[AGENT][POSITIVE] Good. Well, how can I help you?
[AGENT][NEUTRAL] OK, so you're needing eligibility benefits and also you have a question regarding network. Is that correct? I prior?
[CUSTOMER][NEUTRAL] Yes ma'am.
[AGENT][POSITIVE] Yes, ma'am, I can help you. And what is a good
[CUSTOMER][NEUTRAL] Girl, I have lots of questions this morning.
[AGENT][NEUTRAL] Well, I won't, I don't know that I can help you with all of them, but I will certainly help you with the ones that I can, [PII]. So what is a good callback number for you, please?
[CUSTOMER][POSITIVE] Awesome awesome
[CUSTOMER][NEUTRAL] It's [PII].
[AGENT][NEUTRAL] Thank you and the member's policy number?
[AGENT][NEUTRAL] Oh.
[CUSTOMER][NEUTRAL] The member policy number is 01816259.
[AGENT][NEUTRAL] I'm so sorry, but there is something in your background.
[AGENT][NEGATIVE] That is extremely loud.
[CUSTOMER][NEUTRAL] Oh, you know, it's because I have my windows open and I think it's the little birdies. Hang on, let me, let me close my window. It's the little birdies that I have bird feeders outside and they tend to come by in the mornings.
[AGENT][NEUTRAL] OK. OK.
[AGENT][NEUTRAL] Oh
[AGENT][NEUTRAL] Uh-huh.
[AGENT][MIXED] Uh, yeah, I hear them. I mean, it's sweet, but it is overpowering you.
[CUSTOMER][NEUTRAL] Hang on, let me
[AGENT][POSITIVE] Thank you.
[CUSTOMER][POSITIVE] No, you are definitely welcome. OK, awesome, awesome.
[AGENT][NEUTRAL] OK, so did you say 01816259? Was that correct?
[CUSTOMER][NEUTRAL] OK, so.
[CUSTOMER][POSITIVE] Yes ma'am, that is correct.
[AGENT][NEUTRAL] OK, thank you. All right, so one moment please.
[CUSTOMER][NEUTRAL] Of course.
[AGENT][NEUTRAL] And any information, [PII] that I do provide will be a verification of benefits and not a guarantee of payment. What is your patient's name, please, and their date of birth?
[CUSTOMER][NEUTRAL] It's [PII] with [PII].
[AGENT][NEUTRAL] OK, thank you. So I do show that she is a subscriber on the supplemental policy.
[AGENT][NEUTRAL] And this supplemental policy is active with an effective date of [PII].
[AGENT][NEUTRAL] Because it is a supplemental policy to her primary insurance, there is no prior authorization required and there is no network affiliated with this policy. We would just follow her primary insurance.
[CUSTOMER][POSITIVE] Oh, OK, awesome, awesome, and then just do you know if she, if does it show you who her primary entrance is because we have Aetna and we're showing inactive, so I don't know if you had a different one or I can just call the patient and see.
[AGENT][NEUTRAL] I can see what we, I can just tell you what we show on our system. We show it to be Blue Cross and Blue Shield.
[CUSTOMER][NEUTRAL] OK
[CUSTOMER][NEUTRAL] Oh, OK.
[CUSTOMER][NEGATIVE] I will probably bother her and see what's going on with her life today.
[AGENT][NEUTRAL] Uh
[AGENT][NEUTRAL] Uh, yeah, for her employer, we show it to Blue Crosse and Blue Shield.
[CUSTOMER][NEUTRAL] OK, perfect. So I shall call her and see what's going on so we can get her updated and Miss [PII], is there a way I may have a reference number because if you're a supplement plan, it'll just depend on primary.
[AGENT][NEUTRAL] OK. All right. And then do you
[AGENT][NEUTRAL] Yes, so,
[AGENT][NEUTRAL] Yeah. Right. And do you want her outpatient benefit information or?
[CUSTOMER][NEUTRAL] Yes, please.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] All right.
[AGENT][NEUTRAL] OK, so the outpatient benefit maximum per calendar year for covered outpatient services is $1000.
[AGENT][NEUTRAL] And there is no outpatient deductible.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] And if you all do file a claim with us for her [PII], when the claim is submitted to us, we will have to have a copy of the primary insurance company's explanation of benefits as well for review. And then once we have processed our claim here at APL, we do have a portal that you should be able to see uh you should be able to check claim status in and that website for our portal is located at secured.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] [PII]
[AGENT][NEUTRAL] [PII].
[CUSTOMER][POSITIVE] Awesome awesome I will make their little handy [PII] note for sure.
[AGENT][NEUTRAL] All right then. Well, is there anything else that I could help you with today?
[CUSTOMER][NEUTRAL] No, that's all I have for today.
[AGENT][POSITIVE] OK, well then, thank you so much for calling APL [PII], and I hope you have a wonderful day.
[CUSTOMER][NEUTRAL] Oh sorry, what was that reference number or with that reference number?
[AGENT][NEUTRAL] It's my name in today's date. My name in today's date, yes, ma'am.
[CUSTOMER][NEUTRAL] Just be your name and.
[CUSTOMER][NEUTRAL] Uh, some blossom.
[AGENT][NEUTRAL] OK.
[CUSTOMER][POSITIVE] I'm so sorry I probably totally missed it a little space out there.
[AGENT][NEUTRAL] That's OK. [PII] is my first name. OK.
[CUSTOMER][POSITIVE] Awesome awesome.
[CUSTOMER][POSITIVE] Thank you.
[AGENT][POSITIVE] Well, you're welcome. Have a wonderful day, [PII].
[CUSTOMER][NEUTRAL] Mm
[CUSTOMER][NEUTRAL] You too bye bye.
[AGENT][NEUTRAL] Bye-bye.