AccountId: 011433970860
ContactId: 71308401-8e4a-4a87-8dc8-9ccbef3128bc
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 327839 ms
Total Talk Time (AGENT): 173381 ms
Total Talk Time (CUSTOMER): 138398 ms
Interruptions: 3
Overall Sentiment: AGENT=1.1, CUSTOMER=0
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/04/11/71308401-8e4a-4a87-8dc8-9ccbef3128bc_20250411T17:22_UTC.wav
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[AGENT][NEUTRAL] Thank you for calling APL. This is [PII]. How can I help you?
[CUSTOMER][NEUTRAL] Hello [PII], my name is [PII]. Initial to my last name is [PII]. I'm trying to confirm if we are in network with this member's plan and if we can see him.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] Sure, yeah, I can see what network this point support of, uh, [PII], can I get a good call back number from you first in case we're disconnected?
[CUSTOMER][NEUTRAL] Yes ma'am, it's [PII] and that's a direct line.
[AGENT][NEUTRAL] OK, thank you. Do you have the policy number?
[CUSTOMER][NEUTRAL] Yes, it is D for Delta, 43,302,090.
[AGENT][NEUTRAL] OK, so [PII], that's not gonna be one of our policy numbers that is through, uh, they're called 90 degree benefits. So I'm sorry, but these multi plans, they're so confusing so I can give you their information and I can transfer you to them if you'd like.
[CUSTOMER][NEUTRAL] Oh
[CUSTOMER][NEGATIVE] They are the worst.
[CUSTOMER][NEGATIVE] Please, and then if you don't mind giving me a phone number, I have like 8 different phone numbers. I've been transferred at least 12 different times and it this is just a mess.
[AGENT][NEUTRAL] Um yes, no, OK, so before we do any of that, [PII], um, let me ask, what are they being seen for because it's possible they do have a policy with us, um, if you have their social I could search for them in our system.
[CUSTOMER][NEUTRAL] It's just
[CUSTOMER][NEUTRAL] I don't, it's a new patient.
[AGENT][NEUTRAL] OK, um, let's see.
[CUSTOMER][NEUTRAL] It's a new patient. I don't have their social. They're just coming in a routine eye exam.
[AGENT][NEUTRAL] That's OK. Um.
[AGENT][NEUTRAL] Oh OK that's definitely not us we don't offer vision. I'm so sorry, um.
[AGENT][NEUTRAL] That gum, OK.
[CUSTOMER][NEUTRAL] And well, no, no, no, that's the thing that's the thing everybody keeps giving me vision benefits and, and we're, we don't take vision benefits we take medical benefits for because we're considered a specialist.
[AGENT][NEUTRAL] Oh,
[AGENT][NEUTRAL] Oh, I see. OK, but if it's still routine, mm.
[CUSTOMER][NEUTRAL] So that's where I'm like, OK, I keep getting.
[AGENT][NEUTRAL] OK, so I will say um if they have a policy.
[CUSTOMER][NEUTRAL] Like it's for like a cataract ebo.
[AGENT][NEUTRAL] OK, so if they have a policy with us and it's, you know, obviously associated with one of these multi-plans, what they would have with us would be a limited indemnity medical plan and typically it of course it does depend on the policy. Most don't offer any sort of benefits for that. They would have office visit benefits if it was in regard to an accident or, or excuse me, a sickness or an injury.
[AGENT][NEUTRAL] Um, but I mean we could see if you want, um, could you spell their first and last name for me?
[CUSTOMER][NEUTRAL] Yeah, first name is [PII], last name is [PII] and it's spelled with [PII].
[CUSTOMER][NEUTRAL] Date of birth is [PII].
[AGENT][NEUTRAL] OK, give me just a moment.
[CUSTOMER][NEUTRAL] And
[CUSTOMER][NEUTRAL] And sickness. OK, I'm gonna have to notate all this because.
[AGENT][NEUTRAL] It's if it's for cataracts, I mean, I don't know, that's interesting. I don't know what that would be considered.
[CUSTOMER][NEUTRAL] Uh
[AGENT][NEUTRAL] Let's see.
[CUSTOMER][NEGATIVE] And yeah and so I had spoken to a rep earlier and they told me, you know, I don't think y'all are contracted with us and I was like, OK, and then she did mention this is a preventative plan only so he really wouldn't have any benefits for for y'all.
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] And then well I let, I called the patient to let him know and I guess the patient reached out to his insurance and they told him that yes, he, he could see us and that we were contracted and all that stuff. So I just wanna get a definite confirmation.
[AGENT][NEUTRAL] Uh-huh.
[AGENT][POSITIVE] Oh my goodness.
[AGENT][NEUTRAL] Yes, so I do not see him.
[CUSTOMER][NEUTRAL] Before we see him and then he's got a big bill.
[AGENT][NEUTRAL] Sure, and I don't see him in our system, so it does not look like he has a policy with us. If he does, um, or if he believes he does through APL, um, you know, of course we would need his social, um, to try to search that way or if he has his actual, um, policy number with us, um, so I can, I'm sorry, uh I can give you the information for 90 degree benefits give me just a moment, let me get that pulled up.
[CUSTOMER][NEUTRAL] Ah
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] OK uh let me know when you're ready.
[CUSTOMER][POSITIVE] Ready.
[AGENT][NEUTRAL] OK, that phone number is [PII].
[AGENT][NEUTRAL] [PII].
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] [PII] and you would select option one for 90 degree um their prompts are very confusing and one can lead you right back here um but it is option one for them. Did you want me to go ahead and transfer you over now?
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Will do.
[CUSTOMER][NEUTRAL] Please.
[AGENT][POSITIVE] You want me to go ahead and transfer you now? OK, yes, I'm so sorry. I hope you get your answers and everything sorted quickly.
[CUSTOMER][POSITIVE] Yeah, please, thank you.
[AGENT][POSITIVE] Yes ma'am, I hope you have a great rest of your day.
[CUSTOMER][POSITIVE] Thank you.
[AGENT][POSITIVE] Thanks, bye-bye.
[CUSTOMER][NEUTRAL] You too.
[CUSTOMER][NEGATIVE] You are on hold.
[CUSTOMER][POSITIVE] Thank you for calling 90 if you would like to.