AccountId: 011433970860
ContactId: 6e5d687c-3d78-4821-97da-90f895da878e
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 279480 ms
Total Talk Time (AGENT): 138827 ms
Total Talk Time (CUSTOMER): 69650 ms
Interruptions: 0
Overall Sentiment: AGENT=0.7, CUSTOMER=0
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/01/31/6e5d687c-3d78-4821-97da-90f895da878e_20250131T14:50_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] Yes, my name is [PII]. I'm calling to verify benefits for a patient please.
[AGENT][POSITIVE] OK, well, I'll be more than happy to assist 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] [PII]
[CUSTOMER][NEUTRAL] And the ID number is [PII].
[AGENT][NEUTRAL] [PII].
[CUSTOMER][NEUTRAL] No, [PII].
[AGENT][NEUTRAL] [PII]. OK. Thank you. And can you verify the member's first and last name and date of birth?
[CUSTOMER][NEUTRAL] Yes, it's [PII], [PII].
[AGENT][NEUTRAL] Wait a minute, and the I just want to make sure I have this right. The policy number is 2159228?
[CUSTOMER][NEUTRAL] There's a 0 at the beginning, so 02159228.
[AGENT][NEUTRAL] Mhm. OK. Um, the reason I'm asking is because that policy number is pulling up a different member.
[AGENT][NEUTRAL] Would the member that you're speaking of be a dependent?
[CUSTOMER][NEUTRAL] Mm, I'm not sure she didn't specify.
[AGENT][NEUTRAL] What's the date of birth?
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] OK. The name of the member that you gave and the date of birth is not on this policy?
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] Um, and this policy is no longer active, um.
[CUSTOMER][NEGATIVE] It's not.
[AGENT][NEUTRAL] Yeah, this is a totally different name.
[AGENT][NEUTRAL] Do you have a group number?
[CUSTOMER][NEUTRAL] Hm.
[CUSTOMER][NEUTRAL] Yes.
[CUSTOMER][NEUTRAL] 26612.
[AGENT][NEUTRAL] OK, hold on one second, let's try with the group.
[AGENT][NEUTRAL] OK, so since I'm in a new screen, I'm sorry, I'm just gonna need you to repeat the last name.
[CUSTOMER][NEUTRAL] Yes, so it's [PII]
[AGENT][NEUTRAL] What in the world?
[CUSTOMER][NEUTRAL] Hm. [PII] maybe you don't see that there.
[AGENT][NEUTRAL] Oh, I see what happened. It's 251, not 215.
[AGENT][NEUTRAL] OK, so I have the the member here. Um, so it's the, the policy number is 251-9228 and um the policy is active, it's been effective since [PII].
[CUSTOMER][NEUTRAL] 25
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] And what type of benefits did you want to go over?
[CUSTOMER][NEUTRAL] Um, she's coming in for an ultrasound. I wanted to know if that will cover the copay or deductible.
[AGENT][NEUTRAL] OK, so our payments do go towards the copay, deductible and co-insurance after primary, um, it would be outpatient, right?
[CUSTOMER][NEUTRAL] It's yeah it's gonna be done in the office outpatient.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] And she does have the um office treatment. So the, the max is $300 per calendar day.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] That she can use towards the um those expenses, outpatient.
[CUSTOMER][NEUTRAL] OK, is that still available?
[AGENT][NEGATIVE] Well, it resets each day.
[CUSTOMER][POSITIVE] Every day, OK, perfect.
[CUSTOMER][NEUTRAL] OK, and can I have the claims mailing address please?
[AGENT][NEUTRAL] Sure, it's [PII].
[AGENT][NEUTRAL] [PII].
[AGENT][NEUTRAL] [PII].
[AGENT][NEUTRAL] [PII].
[AGENT][NEUTRAL] And the zip code is [PII].
[CUSTOMER][NEUTRAL] 24 OK and do you have a reference number for the call?
[AGENT][NEUTRAL] Sure, so there's no call reference number. You can use my name and today's date. Um, that's [PII], first initial to my last name is [PII].
[AGENT][NEUTRAL] And just for the call, all the information provided was a verification of benefits, not a guarantee of payment. Was there anything else I could assist you with today?
[CUSTOMER][NEGATIVE] No thank you.
[AGENT][POSITIVE] All right, so, well, thank you so much for calling APL. I hope you have a great weekend.
[CUSTOMER][POSITIVE] Thank you you too bye bye.
[AGENT][POSITIVE] Thank you, bye bye.