AccountId: 011433970860
ContactId: 74afcf74-5135-4843-80f6-90ef950a5139
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 535409 ms
Total Talk Time (AGENT): 168102 ms
Total Talk Time (CUSTOMER): 208762 ms
Interruptions: 2
Overall Sentiment: AGENT=1.4, CUSTOMER=1.1
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/03/27/74afcf74-5135-4843-80f6-90ef950a5139_20250327T21:19_UTC.wav
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[AGENT][POSITIVE] Good afternoon. Thank you for calling APL. My name is [PII]. How may I help you?
[CUSTOMER][NEUTRAL] Hello [PII], this is [PII] from Aetna.
[AGENT][NEUTRAL] Hi [PII], how are you?
[CUSTOMER][NEUTRAL] Uh, Aetna member services, and yes, I have a member here next on the line because we have a claim concern that it says that member has an additional uh insurance aside from Aetna, and they mentioned that it's the Medli Medlink gap insurance. Am I calling the correct department?
[AGENT][POSITIVE] Um, yes, it, it, you could be, yes, I'll be more than happy to help you. So you're just wanting to go over the claim?
[AGENT][NEUTRAL] And see if there's um coordination of benefits.
[CUSTOMER][NEUTRAL] Um, I would like to ask for, yeah, uh, actually I would like to ask for their policy ID because on their member ID all they can see is a group number.
[AGENT][NEUTRAL] OK, um, I can help you, but I need to get into the, um, I need to locate the patient first. Um, [PII], may I have a good contact number in case we're disconnected?
[CUSTOMER][NEUTRAL] Mhm sure.
[CUSTOMER][NEUTRAL] Yes, one moment here.
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] For the contact number, it's [PII].
[AGENT][NEUTRAL] Thank you. And so you need, OK, um, do you have the member's full social?
[CUSTOMER][NEUTRAL] Actually I only have the name, date of birth, phone number, and address.
[AGENT][NEUTRAL] OK, what's the member's first and last name?
[CUSTOMER][NEUTRAL] [PII], last name [PII]
[AGENT][NEUTRAL] OK, hold on one moment.
[AGENT][NEUTRAL] So I'm just searching um with the name. Hold on one moment.
[CUSTOMER][POSITIVE] Sure, take your time.
[AGENT][NEUTRAL] OK, so using the members.
[AGENT][NEUTRAL] Last name, I'm not showing as a policy, um.
[AGENT][NEUTRAL] The only
[CUSTOMER][NEUTRAL] Uh, can I spell it again? Maybe I, mhm.
[AGENT][NEUTRAL] Sure.
[CUSTOMER][NEUTRAL] Uh, last name spelled as [PII].
[AGENT][NEUTRAL] OK, hold on one moment.
[AGENT][NEUTRAL] OK, is there any other first name that it can be or is there another policyholder?
[CUSTOMER][NEUTRAL] Um, for her for his wife's name, [PII], same last name.
[AGENT][NEUTRAL] The reason I'm asking is because there's only 24 6 policies with their last name, but I was, um, it's a different first name, so I was wondering if they were the policyholder, um.
[AGENT][NEUTRAL] The only other thing that we can search.
[CUSTOMER][NEUTRAL] But actually I already asked.
[CUSTOMER][NEUTRAL] Mhm, go ahead.
[AGENT][NEUTRAL] No, go ahead.
[CUSTOMER][NEUTRAL] Uh, because I have already asked the member and [PII] is the subscriber as well with the Medlink Gap Insurance.
[AGENT][NEUTRAL] Right, I was just asking because the names that I see here with the last with his last name, they're not [PII]. So I was wondering if it was if it could be another person. But if this, if it is him, then we don't have a policy that
[AGENT][NEUTRAL] We don't have a policy for him. Um, we could search with the full social if you had that, but that's the only way that we can search.
[CUSTOMER][NEUTRAL] Mm, can I go ahead and contact them?
[AGENT][NEUTRAL] I'm sorry?
[CUSTOMER][NEUTRAL] Um, because I mentioned to them that, can I go ahead and call the number? Because I told them that just in case the insurance needs any additional information, I can go ahead and contact them. So yeah, let me just dial their number. One moment here.
[AGENT][NEUTRAL] Sure.
[AGENT][POSITIVE] Yes, that's not a problem.
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Um, what was your name again? I'm so sorry so that I can introduce you to the member.
[AGENT][NEUTRAL] My name is
[AGENT][NEUTRAL] My name is [PII].
[CUSTOMER][NEUTRAL] Thank you [PII]. I'll be placing this call on hold now please stay on the line.
[AGENT][POSITIVE] You're welcome. OK.
[CUSTOMER][POSITIVE] Hello [PII], thank you so much for patiently waiting on the line. So I do now have here [PII], the subscriber of the insurance, and they tried to check um [PII] mhm go ahead [PII].
[AGENT][POSITIVE] You're welcome.
[AGENT][NEUTRAL] OK, and
[AGENT][POSITIVE] Thank you, [PII], how are you?
[CUSTOMER][POSITIVE] Very good, good, thank you.
[AGENT][NEUTRAL] That's good. Do you have a copy of your ID card available?
[CUSTOMER][NEUTRAL] Yeah.
[AGENT][NEUTRAL] And on the ID card, do you see anywhere that says in hospital or outpatient policy certification number?
[CUSTOMER][NEUTRAL] Yeah.
[AGENT][NEUTRAL] And what is that number?
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] Which one? The inhospital?
[AGENT][NEUTRAL] Uh, it's the same number that ML 7.
[CUSTOMER][NEUTRAL] For the
[AGENT][NEUTRAL] It's the same number that ML 7 or 8 at the end is different. I just need the number.
[CUSTOMER][NEUTRAL] Oh, OK, 02283843 ML.
[CUSTOMER][NEUTRAL] And then 8 for outpatient.
[AGENT][POSITIVE] Thank you. Hold on one moment.
[AGENT][NEUTRAL] And I just need you to verify your date of birth and the mailing address on file.
[CUSTOMER][NEUTRAL] Of [PII].
[CUSTOMER][NEUTRAL] [PII] and the mailing address [PII].
[AGENT][NEUTRAL] Thank you, and you're on the policy as well. I just need to verify your date of birth, um, since we're speaking.
[CUSTOMER][NEUTRAL] Oh my, oh, [PII] [PII].
[AGENT][NEUTRAL] Thank you for that and all the information provided is a verification of benefits, not a guarantee of payment. And [PII], are you still on the line?
[CUSTOMER][NEUTRAL] Yes, I'm still here.
[AGENT][NEUTRAL] OK, hold on one moment.
[AGENT][NEUTRAL] So the policy number um with APL is 228.
[AGENT][NEUTRAL] 384 3.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] And we are the secondary.
[CUSTOMER][NEUTRAL] 228-3843
[AGENT][POSITIVE] Correct.
[CUSTOMER][NEUTRAL] Yes, and I would like to confirm that the effective date is [PII] and no termination date.
[AGENT][NEUTRAL] Hold on one moment.
[CUSTOMER][NEUTRAL] Thank you. Take your time. I should, I should fucking.
[AGENT][NEUTRAL] Yes, the effective date is [PII].
[CUSTOMER][NEUTRAL] And then I would like to ask that this um insurance is e-commercial insurance?
[AGENT][NEUTRAL] No, this is a secondary gap insurance and we're second only to the Aetna policy. It's through their employer.
[CUSTOMER][POSITIVE] Thank you one moment here.
[AGENT][POSITIVE] You're welcome.
[CUSTOMER][POSITIVE] And yeah, actually that is all the information that I needed so that I can update here on my end and thank you so much for your help, [PII].
[AGENT][POSITIVE] You're welcome, [PII]. Well, thanks for calling APL. I hope you guys have a great day.
[CUSTOMER][POSITIVE] Thank you so much bye for now.
[AGENT][POSITIVE] You're welcome. Bye bye.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Uh